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APPLICATIC l FOR CONSTRUCT^1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS f�"ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION [x7 COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />OWNER MRILADDRESS <br />CITY 21P PHONE <br />. _ ..... _ . _ _ .�.•nc..-,- RG�.�� 2SL^i�/S� <br />MAIL ADDRESS <br />CIiV Z�P <br />RRCHRECIORDESIGNER MAILADDRESS <br />CIN 21P PMONE <br />(./.ill3�fcN G.orSl <br />��TM Z�p PMONE STATE LICENSE � <br />GENERALLONTRACTOR MAILAODRESS <br />r//��{(ACN Gc.�S7 'L13�- N/GH�.t+7' .g� F�F�¢j T iEwl LSi-1YS� N/a�89�Af L3��// <br />MECMANICALGONTRACTOR Np�LADDRESS <br />CITY 21P PHONE STATELICENSE� <br />PWMBINGCONTRhCTOR MAILADDRESS GTV ZIP PHONE STATELICENSE� <br />Dn�( BFr�MCs �Yn rRo�.En e� -rr `7�i LS9�.YS� D�iaFs s l6ScIQYc <br />CONTPACT PRICE OF WORK <br />INVOLVED <br />r <br />PeROrPOSEO USE OF BU" OING <br />/`l YIOrY�F — <br />IEGRL OESCRIPTION OF PROPERTV (SHOWN BELOW OR ARACN TVJO COPIES) <br />�oT� a�aK -�_ oF P � � e � <br />Fi,c.rrr n/v�S��r� <br />PRRCELTA%I.D.NUMBER <br />�f �`% I– %�� � O I O– O U J <br />CONSTRUCTION LOAN LENOEf�. ADDRESS, TEIE <br />� n NE� �� f,.�.r� 2��t <br />PROJECT ADDRESS 1`] � 7 AI�J S <br />0 <br />G <br />FLOOR <br />SINK <br />OF FIICTURE OR ITEM <br />SINK & <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACH / <br />./l..c � �fi1 <br />tYPF OF CON51. <br />SIZE OF BL� <br />{�C.% 1 `J� �C� <br />pCCUPA� <br />REASON <br />iNTANE BV <br />LOT AREA <br />NO.OF STORIES <br />I <br />FIRE SPRINNLERS REO'D <br />FIREAU MREOO� <br />N� <br />PLANS APP�70VF,D OV <br />J i— <br />DATE lL�7�l �! <br />$ <br />$ <br />SIDE <br />GONTACT PERSON AND PHONE NO. �^RR Y N�J Ldiyi Z.S 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 OP.fIINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED W TH WHETHER SPEC�FIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR 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 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />� t� � <br />s�cN�iuAe i Y 3�. o�re Y-/Y-9Y <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATEi <br />WOOD STOVE <br />METAL FIREPI <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />TOTAL <br />$ <br />PLAi//EIK//IR I rc�/�YJ�-1 /!l✓// <br />�CANT S�TE <br />❑ YES u NO BUILDING <br />INV�N�V NOOip'MW460NIi5 —� <br />�aV�� p 1 PLUMBING <br />C. J <br />4SEMENT MECHANICAL <br />❑ YES " NO <br />EIGHTLIMRATION ADDITIONALPLANCHECK <br />� OTHER <br />STATE BUILDING SURCHARGE <br />CfTY OF EYERETT PUBLIC WOfiKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />