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APPLICATIO" FOR CONSTRUCTC'�N PERMIT � <br />\^ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�r �lY <br />�V <br />HEATING SYSTEM: ❑ GAS i] ELECTRIC ❑ <br />BUILDir1G DEPARTMENT <br />259-8810 <br />I DEMOLITION ❑ COMBINATION <br />OWNER MAILADORE55 <br />MRIL AODRESS <br />ARCNITECT OR DESIGNER <br />!:1 BUILDING i 1MECHANICAL XPLUMBING I, SIGN <br />(� GTV q21P( 1 PHONE <br />'Yrj� v PrPTT l D O�V `-J <br />I� <br />CITY Zi' PNONE <br />21P PMONE <br />GENERALCONTRACTOR MAILADOFE55 qTY 21n PMONE STATELICENSE� <br />MECHFNICALCONTRACTOR MAILAODAESS QTY ZIP PHONE STATEIICENSE� <br />�i __J. /'__.l� �_ _�z �–. N1 V�i.� 9�nu �.�oL-�r-a�s 5{�.�o (c-k r31 C,1T <br />MAIL ADDRE55 <br />GONTHACT PRICE OF WORN <br />DESCRIBE WORK AND SQURRE FOOTRGE INVOLVED <br />PROPOSED USE OF BUILDING <br />�n J�1S< <br />LEGAL OESCRIPTION OF PROPERTV �SHOWN BELOW OR ATTACM TWO COPIES� <br />LOT BLOCK Of <br />IARCELTAXID.NUM9ER <br />1 D 9 U N•%� �•Y k l7r <br />CONSTRl1CTION LOAN LENDER. ADDRE55, TELE MONE NllA1BER <br />PROJECT ADDRESS <br />PLUMBING <br />NO. TYPE OF FlI(TURE OR ITEM FEE <br />WATER CLOSET (TOII.ET) <br />BATHTUB <br />U LAVATORY (WASH BASIN� <br />—f SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRIPlKiNG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />FRnNTSETBACN RERflSET9ACK <br />USE ZONE <br />7YPE OI CONS7. <br />SIZE OF BLOG. <br />OCCUPANCYLOAD <br />REASON <br />INTANE BV <br />SUB TOTAL $ <br />PERMIT 8 <br />707AL FEE $ <br />LOi AREA <br />NO.OF STORIES <br />FIRE SPRINKLERS PEO'0 <br />FIRE ALAFM REOD <br />PLANS APPROVEO BV <br />DATE <br />ZIP PMONE STATE LICENSE Y <br />PHONENO <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINE� 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 GHANTING 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 />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUl'HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �, ,�� Y/Y�� <br />SM�N�LUPF ��TE <br />CIiY NIl5ME554LENSE YO <br />EOUIPMENT � FEE <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLA <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT $ITE �CCJ <br />❑ YES ❑ NO BUILDING <br />occuwNcr xoor�,vuiixeuxrts <br />ceour pLUM81NG <br />BASEMENf MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT L'MITATION ADDITIONAL PLAN CHECK <br />OTHEH <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES – <br />rev ennc is atn5 TOTAL <br />M E.A. <br />SUB TOTAL $ ' <br />PERMIT S � <br />TOTALfEE $ <br />FEE RECEIPT NO <br />VALUATION FEE <br />i <br />� <br />i <br />� <br />i <br />i <br />i <br />/ /A , <br />� <br />