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� `�`^`��=='� APPLICATIC�1 FOR CONSTRUCT'-1N PERMIT � �sc, <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS �J ELECTRIC �J <br /> 259•8810 <br /> i ' DEMOLITION `�t COMBINATION I I BUILDING I MECHANICAL I_I PLUMBING � 1 SIGN <br /> OWNEP h1AILA0DR[SS CIiY ZIP PNONE <br /> �G,��� �� Aw�n�°N J����- 1J`�TOn/ Ci�t'Qc�d� %`�7c1 � 52 /`j S / <br /> TENANT hIMLADDRESS CIiV ZIP PNONE <br /> AIiCNITECTOBDESIGNER MNL�D�FESS CIiV 21P PNONE <br /> �'.�/ i�/ = 4�` <br /> GENER4LCONT(i�CTOR �.1qILqD�FE55 GTV ZIP PNO`!f SiqTELIGENSEa <br /> owNC /� <br /> 6fECHANICAICONfR4CTOP MPILAD[1RE55 CIT" ZIP � PHONE STATEUCENSE� <br /> PI UM81NG CONiR�CTOB l,7AIL ADDfiE55 CITv ZiP PNONE ST�TE UCENSE M <br /> CONTRAGT PRICE JF WORK <br /> .j c% c� O <br /> OESCRBEWOP.N ANU SOUAPE FOOTAGE INVOIVED CONTACT P[Ii50N AND PHONE N0. <br /> 1 r,a /� o�� �' c, i���-� J <br /> PPOPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ .4ND EXAMINED THIS <br /> � /1� { ` �� APPLICATION AND KNOW THE SAME TO BF TRUE AND CORRECT.ALL � <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �Ew�oescRIPTIONpFPqOP�ERyTY�SfAW'lQELGWORATiACHTWOCOPiES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED hIEREIN OR <br /> LOT �� �d otce<� � 7 oF �v e� e'�"'� NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � ✓� ��Z D I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> rn�qXlD NOAI9ER APP N IS MADE AND I COMPLY WITH THE STATE <br /> � ! � CO R LAW J�.2 RCW 296.200 WAC. <br /> CONSTPUCTIONLOANLENDER.AODR'cSS.TELEPHONENUMtlER � � <br /> - � - l-qy <br /> PROJECT ADDRESS � (,/r�1 J�,o�t7a .� p acv.�nc ��rE <br /> � C���(i cirrfiusrt�essua:nsu,o -- <br /> PLUMBING MECHANICAL <br /> NO. TY!`E OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT •FEE <br /> WATER CLOSET�TOILET) � A/C—AiHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ' <br /> SHOWER � CLOTHES DR'/ERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � — <br /> DISHWASHEF RANGE HOOD —�— <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) —�—_ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP —r— <br /> BACKFLON!PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETC.) � � <br /> � <br /> SUB TOTAL S ; SU[3 TOTAL 5 ' <br /> PERMIT § PERMIT S ; <br /> TOTAL FEE S ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBACK liEARSETBFCN SIDESETBACK PIANCMEGNNUAIBER FEE RECEIPTNO <br /> usezone �OTqREA V�CANTSITE FEES VALUATION FEE <br /> . �. YES .-��. NO BUILf`ING <br /> iYPEOfLOHSi NOAFSTORIES acurzvtv hcorpµnu`zu�:ns <br /> cFou� pLUAI8ING i <br /> i <br /> SI7.E OF OIOG FIRE SPflI1JNLERS REO'D BASEMENi <br /> MECHANICAL <br /> YES -� NO <br /> OCCUPANCYIO�U FIRE�LARfdREOD NEIGHTLIIAIiqTION AODITIONALPLANCHECH <br /> OTHER ' <br /> REASON <br /> i <br /> —�_ <br /> S7ATE BUILDING SUPCHARGE <br /> IHiAKE BY PLA�ISAPPROVEOBV CITY OF EYERETT Pl1BLIC WORKS i <br /> LOCAL SALES <br /> onte TAX CODE IS 3105 rora� <br />