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APPLICA'�'IC�f FOR CONSTRUCT�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />259-8610 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING jC� MECHANICAL ❑ PLUMBING ❑ SIGN <br />OYMER M�IIADDRE55 CIN 21P PNONE <br />!e.-�a n a�..,�� s�a� moROA,✓ Ro E✓ERETT 9aao3 �sS-isii <br />TEN�NT MAIL ADDRE55 dTV Z�P PHONE <br />ARCHITECT OR DESIGNER <br />21P PHONE <br />GENERALCONTRACTOFi MRILADDRE55 CITV 21P VHONE STATELICENSE� <br />MECMANIGILCONTRACTOR MAIIADDRE55 qTV Z�F' PNONE STATELICENSE• <br />��E-qL E�/E�t6Y /99�/ G'✓n� AvF W�YNNwoo� 9?036 �J9y p��s Yo�rotESobL TN <br />PLUMBMGGONTRACTbA MAILADDRESS CIN ZIP PMONE STATELICENSEI <br />CONTRACT PPICE:iF WORK <br />�j/(oO.PO � <br />DESCRIBE VIORK �ND SOU�RE fOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEOAL OESCRIPTION OF PROPERTY (�0� BELOW OP ATTACN TWO COPIES) <br />LOT — BLOGK Of <br />PARCELTAXI.D.NUMBEH <br />,�933 -o <br />CONSTRUCTION LOAN LENDER, <br />000 <br />NUMBER <br />N0. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WAS <br />SHUWER <br />KITCHEN SINK 8 <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />URINAL <br />DRINKING FOUN <br />FLOOR DRAIN <br />BACKFLOW PRE <br />ROOP DRAINS- <br />SINK ISERVICE- <br />SUB TOTAL $ <br />FOR OFFlCE USE ONLY: <br />FRONTSEiBACK REARSETBACK <br />USEZONE <br />7YFE OF CUNST. <br />SiZE OF BLDG. <br />OCCUPANCVLO�D <br />REASON <br />INTAKE BY <br />LOT AREA <br />OF STORIES <br />FIRE SPRINKLERS REO'� <br />PLANS <br />DATE <br />FEE <br />VACANT SITE <br />❑ YES ❑ NO <br />occuvercr xo aownuxeuHrts <br />GRWP <br />BASEMENT <br />n ves ❑ No <br />NEIGMT LIMITATION <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACi PEHSON AND PHONE NO. <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BF TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE <br />AUTHORI?Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW RcGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x G� .,�s�..� a/ay/9.y <br />SIGN�TUPE A q A� �� D�TE <br />MECMANICAL <br />FORCED AIR SYSTEMS-B.T.U. <br />UNITHEATERS-B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACE INSERI <br />HEAT PUMP <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WGRKS <br />TOTAL <br />SUBTOTAL $ O ' <br />PERMIT $ i � i / <br />TOTALFEE $ � -' " <br />FEE RECEIPiNO. <br />VALUAiION FEE � <br />i <br />i <br />i <br />i <br />i <br />i <br />_ <br />i <br />i <br />i <br />i <br />I <br />