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e <br />APPLICATIt�"1 FOR CONSTRUCT"'7N PERMIT � <br />n TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />��l% <br />BUILDIN(i DEP T HEATING SYSTEM: � GAS ❑ ELECTRIC O <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION [� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEP MqIL�DDRE55 CITY IIP PHONE <br />'7 <br />'1�i�ne�i lu�i/1a�c /J�r/Q .�.a�tQ�f-� % i�-jj�5.(ir./Y/oz G-l/ERE'i7l1�'N � �20� 33�-�9� <br />T NAN�— MAIL ADDFESS GITY ZIP PHONE <br />ARCHITECTORDES:GNER MAILADDRE55 <br />v�tK=�l-u/�n Dh�i�'t� �,<o,rJ. Co <br />:! II" � C /- P�!�� (fj/5��� 7� <br />[CHRNICALCIXJTRACTOR MAI�ADDRE55 <br />� 1� 5 �%/'a�i`t�y ���. L <br />BINGC TRAC70R AI AOORE55 <br />'� d F�/ l['! � <br />DNT ACT PRI�� jE OF WORK <br />�%!J C� �i � � <br />,�/�/�Y q/•� �/tis, <br />S <br />/65 <br />7� <br />CITY ZIP PHONE <br />/�i�i��/i .P4� .> >JA��7J/'Sl L!% <br />cirv _iFI�P:-�F4tm� <br />�/-7E� <br />E ��/ 7�"f <br />/ il��vL' i/'d. !�i/i �' "1Y�.�l� �z .'Z� �(o.rr s <br />CITV ZIP PHONE � STATE LICENSE t <br />��' .�` %%h�i � �%nRO� 1.l9/77. `%�Pi .277i <br />CITV IIP PHONE STqTEUCENSE• <br />(v J -S- Lb <br />/ <br />5� � CONTACT PERSON AND PHONE NO. <br />�ur �/�7� �«/c �%'ql�l��G ��7- a6� � <br />PRO SED USE OF BUILDING <br />d5 • <br />LEGAL DESCRIPTION OF PROPEflTV (SHON?! BELOW OR ATTACN TWO COPIES� <br />�oT / BLOCK �O�'C�pF fRi9n'� �r fa.�aG/a <br />PARCELTA%ID.NUMBEfl <br />73 �s-000-�o / _ �oo / <br />� CONSTRI'.:TIONIOANIENDER.ADDPE55.TELEPHONEN7M0ER <br />,D./i.�si7nrl m�a�rvQ �tP �Gtmap� <br />NO. TYPE OP fll(TUpE OR REM <br />WATERCLOSET(TOILET) i <br />BATHTUB � <br />LAVATORY (WASH BASIN� ��� <br />SHOWER <br />/ KITCHEN SINK 8 DISP / � <br />DISHWASHER / <br />LAUNDRYTRAV � <br />CLOTHES WASHER / <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />I - SINK (SERVICE-BAR, ETC.) i <br />FOR OFFICE U5E ONLY: <br />FRON;�E fACK R�OR; <br />SIZE OF <br />INTAKE BY <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />OF STORIES <br />FIRE SPRINKIEflS REO'D <br />� Sf A!' <br />FIRE ALARM REO'D <br />PUN$ AqPRQVEO BY <br />tir � <br />OATE Is��L�G <br />� 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 TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE IiRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS �1ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />NO. I TYPE <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS = <br />VENTILATION FAN <br />RANGE HOOD , <br />WATERHEATER i <br />WOOD STOVE �_,�.� <br />METAL FIREPLACE (WOW <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN I I I <br />1CANT SITE FEES <br />pves ❑ No — <br />1'�' BUILDING <br />LOG�NLV NOIXpW[LLRIGUNi15 <br />y°� PLUMBING <br />\SEMENT MEC`1ANICAL <br />❑ YES NO <br />_ICH7uMi7A7iON ADDITIONALPLANCHECK <br />�' <br />OTHER <br />STATE BUILDINCa SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAI <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />�� <br />zo- 9i <br />NO. <br />FEE <br />'/J <br />� <br />�� <br />