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APPLICATIQ'~ FOR CONSTRUCT�"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: �AS ❑ ELECTRIC ❑ � <br />259-8810 <br />I 1 DEMOUTION I i COMBINATION BUILDING �4iAECHANICAL i' PLUMBING f i SIGN <br />OWNER ��1A�LADORESS GTY ZiP PHONE <br />�k �04o N►7,� �� �, � �-nerr 9�.�0 3 as� -�.Ss b <br />tENAN MAILADDRE55 CITV 21P NMONE <br />ARCMITECi OR OESIGNER <br />GENERALCONTR4CTOF <br />MECN4NICALCONTRACTO <br />/ <br />PLUMBING CONiRACTOR <br />CONTRAC�T PFeICyE �OF �M1'QBf� <br />l:..CJ��t�CJ <br />D SCRI E WO K AND SOU I <br />\ <br />�� <br />PRO OSED EOFg1yLDl <br />MAIL ADOPE55 <br />MAIL <br />LEGAL UES�PR�PERTY �SHOWN BELOW OF ATTACH TWO GOPIES� <br />LOT BLOCK OF <br />PARCELTA%ID.NUMBEIi <br />GONSTRUCTION LOAN LEN�ER, ADDRESS. TELEPH0I:E NUMBER <br />? /lJ��.�! G!/uC. ,� �i i <br />PLUMBING <br />Np, TYPE OF fll(TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDR'! TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.� <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBALK REAR $ETI <br />USE ZONE LOT AREA <br />TYPEOFCON51. <br />SIZE OF BLDG. <br />BY <br />NOAF <br />FIRE SPRINKIERS RE00 <br />FIRE �I�FM RE00 <br />PLANS <br />DATE <br />GTV 2iP <br />CITY ZIP <br />GIiY ����y 'Z.IP^ <br />4�GFaCX! W <br />CITV ZIP <br />FEE <br />0 <br />� <br />PMONE <br />PHONE SiPiE UCENSE • <br />pPN�ON^E STATE UCENSE � <br />PHONE I �� TE LI� OL <br />CONTACi PERSON PFD PNONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 V�'ITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOtS NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LP'N REGULATING CONSTRUCTION OR THE <br />PERFORA7ANCE OF CONSTRI,CTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS MAD AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 182 CW AND 296.200 WAC. <br />� <br />S�fN�IUR[ ��tE <br />CiiV BOSMESS l iC[NS[ NO <br />MECHANICAL <br />NO. TY�E OF E�UIPMENT FEE <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS— <br />UNIT HEATERS—B.T.U. M � <br />CLOTHES DRYERS <br />VENTILATION FAN � <br />--i— <br />RANGEHOOD ' <br />WATER HEATER <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) <br />� <br />FIREPLACEINSERT <br />HEAT PUMP ' <br />GAS PIPING � <br />EXHAUSTFAN <br />SIDE SETBACK FLAN CNECN NUMBER <br />vncnr+t srte FEES <br />�—'' YES i i NO BUILOING <br />occu�a�+cr xoorrM1VEwxcum�rs <br />�a0�° PLUMBING <br />BnSEMEr+T MECHANI:.AL <br />� YES ❑ NO <br />HEIGHT LIMITATION PDDITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTRL <br />TOTAL $ <br />NIT g <br />FEE � RECEIPTNO. <br />�u <br />tl <br />� <br />� <br />