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APPLICATIC"1 FOR CONSTRUCT'�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS J�ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION '�UILDING D MECHANICAL ❑PLUMBING ❑ SKiN <br /> OWNER MAIL�DDRE55 CITY ZIP PHONE <br /> SaNG W. krM �73�-36t� SC EuE¢e'tz, q82�j. ?_�F� If-k.f' <br /> tewwr u���ooness cm na PIMY'F <br /> SAM�C— . <br /> MiLNRECTqiDE51GNER MARADDRESS CRV ZIP PHONE <br /> OENEIULCONTiV1CTdi MARADDRE55 CITV ZIP PMONE STATELICEpSE� <br /> MECNN/IGALCONiMCTOfl WIL�DDRfSS CITY 21P PHONE STIRELICENSE� <br /> VLUTABM6LONTRIICTOR GA0.MD11ESS CITY 21P PMONE ST�TELILENSE� <br /> COHfMCT PR�ICEyO�F�W/A�IM( <br /> � _S (/{/✓� I� <br /> � DE WdM AND SOUARE fOOTMiE MVOIYED �pNT�CT PERSON AND PMONE NO. <br /> � �//'liKi.�c G� �� <br /> i I HEREBY CERTIFV THAT I HAVE READ AND EXIIMINED TMIS <br /> � rnovoseo u ona APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> '� ' �-- PROVISIONS OF UWS AND ORDINANCES OOVERNINf3 THIS TYPE OF <br /> � LE6ALOE8CRIPiqNOFPROPERTY�SHOWNBEIOWONATfACHTWOCAPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRAkTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or �� � AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL UW REGULATIN6 CONSTRUCTION OR THE <br /> i PERFORMANCE OF CANSTRUC?ION.THAT 1 AM AUTHOR2ED BV THE <br /> . i / _ OWNER OF THIS PROPER?V TO PERFORM THE WORK FOR WHICH <br /> ���' APPLICATION IS MARE AND 1 COMPLV WITM tHE STATE <br /> , r�nce�nuc i.o.nrm�eEn COt.�TRACTORS UW 18.27 RCW AND 2962D0 WAC. <br /> CONBTRlICT10N LO�N IfNDER.AOORESS.TELEPIIONE NUMBER ��,J� C�/ ' )�N' �//// �. <br /> Y / b <br /> r�o�c��oo�ss�,�na a � S�.r� �,,� <br /> y+� cm euewees uc[�se uo <br /> �LINOMG IA6q1ANIf.�L <br /> N0. T�E OR fIXT1NIE 011 REM FEE N0. TYPE OF EOlMP1AENT FEE <br /> , / WATER CLOSET(TOILET) � N�IVHNDLG UNITS—+1.P. � <br /> . � BATHIUB ' FORCF.D AIR SYSTEMS—B.LU. M E.A. � <br /> , LAVATdiY(WASH BASM) � UNIT HEATERS—B.T.U. M � <br /> � SHpWEp � CLOTMES DRYERS � <br /> . KITCHEN SINK 8 DISP � 1 VENTILATION FAN ; <br /> ' � DISHWASMER � RANGE HOOD � <br /> � LAUNDRY TRAY ; WATER MEATER ' <br /> � CLOTMES WASHER � WOOD STOVE � <br /> URMAL METAL FIREPLACE(WOOD BURNINfi) � <br /> DRINICING FOUNTAIN i FIREPIACE INSERT � <br /> ' FLOOR ORAIN � MEAT PUMP � <br /> . BACKFLOW PREVEN?ERS ; GAS PIPING ' <br /> ROOF ORAINS--RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE�AR,E?C.) ; ' <br /> � <br /> � i <br /> � <br /> I , , <br /> � � <br /> � SUB TOTAL E ; SUB TOTAL { ' <br /> ; PERMIT S � PERMIT { � <br /> ' TOTALFEE f ' TOTALFEE { ' <br /> FOR OFFICE USE ONLY: y/570 <br /> FPONT 6ETBACK RE�R SETB�CK SIDE SETB�CK PLAN CHECK NUTAPER FEE RECEIPT HO. <br /> �r��2v s <br /> UBE ZONE LOT ARE� V�GANi SITE FEES VALUA110N FEE <br /> ❑ YES ❑ NO BUiLDiNG 'C <br /> TYPEOFCON57. NO.OFS70iilE5 oCawMcv xoapVFUMtuMrts � <br /> I/ . / J �w� PLUMBING i <br /> I � ry <br /> SRE OF BLDG, FIRE SPflINKLERS RE00 BASEMENT MECN�NIC�L � <br /> � 3 .FY. f 1J� ❑ ves �o , <br /> OCCUPANCYlOAO F�AEMAPMREOD HEIGHTLIMITAtiON ADDITIONALPUNCHECK � <br /> i <br /> � N� OTHEF <br /> 11EASON <br /> STATE BUILDMG SURCHARGE �r <br /> liTM(E BV %AN �ROVED BV Gir OF EYERETT PUBLIC WORKS � <br /> LOCAL t11LES , <br /> D�TE ..� - J TAX CODE IE 7105 tOT�L <br />