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APPLICATIQ��: FOR CONSTRUCTf�N ��'� -�,, <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />SFp 26 �94 <br />BUILDING DEPARTMENT �— <br />259-8810 <br />❑ DEMOLITION [ 1 COMBINATION <br />O NEP yAILq�DRE55 <br />MAIL FDDiiE55 <br />UAII ADDRE55 <br />CONTP�C70R <br />HEATING SYSTEM: y�G1CS U ELECTRIC a <br />p osE��Ec��nt � <br />_ LEGAL UESCRIPTION OF PROPERiY ISNOWN BELOW OR PTTACH TWO COPIES� <br />��T BLOCK OF <br />PARCELTA%ID.NUMBER <br />N0. <br />LAVATORY�WASH BA'. <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTHAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLC �R DRAIN <br />BACKFLOW PREVENTi <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTS[TO�CK qEMSEiOACK <br />USE20NE LOT�REA <br />TYPEO(CONSi NOAFSTORIES <br />SRE OF ��DQ FIRE $PRINNLERS REO'D <br />OGCUP�NCV LORO FlRE AIARM PEO'D <br />INT�NE OV PLANS APPROVEO BV <br />DAIE <br />SIOL SETBAGK <br />! BUILDING <br />CiTY <br />CITV <br />CITV <br />FEE <br />f vMdECHANICAL <br />IP PMONE <br />� � r.� rP" i � <br />21P PHONE <br />ZIP PHONE <br />ZIP PHONE <br />�T�,���ti �a i3 <br />ZIP PHONE <br />CONiACT PERSON AND PHONL N0. <br />Putlic YJorks Dept. <br />❑ PLUMBING : ] SIGN <br />? �n 2 �c; �- �S <br />STATE UCENSE a <br />1- <br />STAiE LICENSE • <br />�f�Cll, /I <br />STATE 1 �CFNSF s <br />�w �r �rn - ��` ( � l V ` / /Ld L <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE 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 PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I �M AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THF STATE <br />CONTFj�QCTORS LAW 18.27 RCW AND 296200 WAC. <br />MECNANICAL <br />NO. TYPE OF EOUIPMEN' <br />AiC—AMNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <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 BUF <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLANCHECKNIIIdp[R � FEE <br />❑ YES ' 1 NO BUILDING <br />OCCpcANCv 110 O�OIVRLi!IGUYitS <br />c4ouv pLUMBING <br />oASEMENi MECHANICAL <br />f ; YES � �, NO <br />HEIGIiTLIMITATION ADDI710NAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CIiY OF EYERETT PUOLIC WCRNS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />5 <br />FEE <br />