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APPLICATIC^l FOR CONSTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS O EIECTRIC ❑ � <br />259-8810 <br />f] DEMOLITION ❑ COMBINATION ,V_f BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN MAIL RDORE55 CITV 21P PNONE <br />���� �v���,;-��� s;.�s ��i�FJ ��� r-�;�� ��� ��-��-��� <br />TENANT <br />S�ri ! <br />ARCNITECT <br />MAIL ADDRdSS <br />:ONiRRCTOIi MAILADDRE55 <br />2/�� <br />�LCONTRACTOR MAILPDDRE55 <br />CONTR�CTOR MMLADORE55 <br />' PflIGE OF WORK p <br />� C�� /� 0 / L <br />VIORKAIyDSpUAREFogT,AG INVOLVEI <br />/��'.U�i �f- G!!�/� <br />%(�l2fF'oD�2,�e <br />7lF sq �-1 . <br />CIT� <br />GITY <br />arv <br />ZIP PHONE <br />ZIP PHONE <br />21P PHONE <br />ZIP PHONE <br />ZIP PHONE <br />PERiONANDPHONENO� � <br />STATE LICENSE � <br />R <br />� I HEREBY CEflTIFY THAT 1 HAVE READ AND EICAMINED THIS <br />PROPOSED USE OF BUILDMG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEG�LDESCRIPTIONOFPROPEflTY�S/NO/WNBELOWORATfAGHTWOCOPIE'S/� �/� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�or � a�ocK —L� oF �C ���� ���� f'*���U� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />� �— AUTHORITY TO VIOLATE OR CANCEI THE PROVISIQNS OF ANV <br />�, S -{l ��' �j` '� ���Q OTHEH STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />n /,�� /'PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />!' �/'�` `� �� � %D�O �7r �% ,��(�!("iz OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />f P�RCELTAI( Nui - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�� ' D�� �O /-DDO CONTR/AC�TORS LAW 1827 RCW AND 200 WAC. <br />� CONSTRUC LdWLENDER.ADDRE55,TELEPNONENUM Efi ,/ / '//�� <br />; .5�/ 5 ��L/t /P, 3s� �a �1c� y N CCt.�-� // � �'3 - 5'� <br />�� PROJECT 1DD11E88 sarurinc � o�*e <br />9 <br />BATHTUB <br />KITCMEN SINK 8 DISP <br />DISHWASMER <br />URINAL <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--RAINLEADERS <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFlCE USE ONLY: <br />PRONTSETBACK RE�RSETBACN <br />ZO � 2!F' d � <br />USE IONE LOT AREA <br />-1 GO X �� = �'X <br />7vPE OF CONST. NO. OF STORIES <br />y-h{ <br />52E OF BLOG. FIRE SPRINKLEFS REO'D <br />�7G S F. u <br />O:CUPANCY LOAO FIRE AUFM REO D <br />RFASON <br />INiAKEBY PUNSAPPROVED <br />DATE �f / � <br />TYPE <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />.,..,�.,..�..� ...........__...__. _.. <br />S <br />VRCANT SITE FEES <br />❑ YES � NO BUiLDiNG <br />OCCU�e�kv �IOo�NKwNGUNrts <br />�"a'" � pLUMBING <br />BASEMENT MECHANICAL <br />c; ves ❑ No <br />HEIGNTLIMITATION ADDITIONALPLANCHECK <br />i <br />I OTNER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORNS <br />LOCALSALES <br />TAX CODE IS 3105 �TAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />/ <br />/ <br />� <br />� <br />� <br />