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APPLICATIC�1 FOR CONSTRUCT�'IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS O ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />Cl DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MRILADDRE55 CITY ZIP PHONE <br />�1,�,�y G� l�maE s�s n��ss�ri f�flw� 9�mr �sz-saos <br />TENANT � MAIIADORE55 dTY 21P PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRE55 LITV ZIP PNONE <br />CONTRALTOR MAIL�DDRESS <br />MAII AUDRE55 <br />CONTR�CT PRI�CE OF �W�ORK p <br />.S�i <br />CITY ZIP <br />CITY 21P <br />CITY ZIP <br />PNONF STRTEIICENSE� <br />P40NE STATE LICENSE ' <br />PMONE STATE LICENSE � <br />CONTACT PERYIN AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS <br />PROPOSED USE OF BU:LLIING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />G _�E PROVISIOIJS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />LEGALOESCRIPTIOtlOFPROPERTY�SHOWNBELOWORA7IACHTWOCOPIES) WORK WILL 3E COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />PCAT bf= EVEILET� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�or_.L_l�3— e�ocK �� o� AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�I V lSlOh� � V�L� � Wi• � Snk`J� �.U. OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF fONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />}/ �{" �_p OWNER OF THIS PROPERTY TO PERF� RM THE WORK FOR WHICH <br />L ��n ` t � /`3 — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARLEITA%I.D NUMBER CONTRACTOFS LAW 1B27 RCW AND 2%200 WAC. <br />N3�5-8Z7 - r�l - Do� <br />CONSTPUCTIONL NLENDER.ADDRESS.TEIEPHONENU BER I <br />ee. � f -G -93 <br />PROJECT DDRESS � s�crNru��� o�re -- <br />RUA4 ��itteu E.uF'QE[i Iw:A.qC2D� I CItYBU5ME551IC�15E�N'� <br />NO. TYPE OF Fl7RUNE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN; <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />� DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIP: <br />BACKFLOW PREVENTERS __ <br />ROOF DFAINS—RAINLEADERS <br />SINK (SERVICE—BAR, EiC.) <br />SUB TOTAL $ <br />TOTAL <br />FOR OFFICE USE ONLY: See (C <br />FRCNi�ET9ACN REAR SETBACK <br />n 1 � � I <br />USE20NE <br />iVPE.O.�i CyO�NST. <br />1/ -i <br />REASON <br />INTANE BV <br />OT ARER � <br />� 7 �v _ <br />No. or sroaies <br />FIRE SPRINKLERS IIEGD <br />A REO'D <br />Na <br />PLANS A� OVED BV <br />DATE 7 /� /S <br />TYPE OF EOUIPMENT <br />IV�A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS-6.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYER; <br />��ENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METALf1REPLA <br />FIREPLACE INSI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />°' RMIT $ <br />��� # i -y3 << � 3 = <br />SIDE SETBRiK ALAN CHE � VUM�% FEE� n� <br />v �� <br />VACRNTSITE FEES VALUAi10N <br />❑ YES _ NO BUIIDING ��p,�Z <br />OCNWNLV NOdVN[LLINGIIKIiS <br />�AWv PLUMBING <br />BASE ENt � ME�4pNICAL <br />❑ YES La'NO <br />HEiGHTIn�ITAT1oN AODITIONALPLANCHECK <br />� ' <br />OTHER <br />STATE BUILDING SURG�.ARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />� <br />NO. <br />i���0 <br />� <br />� <br />