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APPLICATIO� . FOR CONSTRUCTf - �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BU:IDING l�'MECHANICAL d�LUMBING ❑ SIGN <br />��fli'1� `��u�'�11��'�, ���115� Ml1K114CC� l3l�l'�,�,rE P��(rLv-�`l�� <br />TENANT MAILADDFESS CITV ZIP PMONE <br />�RCHITECTORDESIGNEP MAILPDORESS CITY ZIP PMONE <br />GENERALCONTRACTOP MAILAUDRESS CITV 21P PHUNE STATELICENSE� <br />5 q� <br />�v�R�s>>aiK��r <br />MECH/JlICAICONTRACTOR MAILAUDRESS CITY ZIP PMONE STATELICENSEII <br />_ .� ..._. n . ,� .� � .�li...;,,, 1�.r �. �Il T=�YL' C1Gl/'l� <br />AODRESS <br />CONTMCT PBIGE OF WORK 1.— <br />h <br />DESCRIBE WORK AND SOURRE FOOTAGE INVOLVED <br />n <br />PROPO` EDUSEOFBUILDING ��i rf ��C-� <br />�L <br />LEdAL UESCRIPTION OF PROPERN �SHOWN BE�OW OR ATTACH TWO COPIES) <br />�pT BLOCK — OF <br />P�RCELTA%I.D NUMBER � <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORV(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PPEVENI <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />FOR OFFICE USE ONLY: <br />FRONTSETBPCK REAR: <br />TYPE OF CONST. <br />SIZE OF BLW. <br />INTAKE BY <br />TOTALFEE <br />FIRE SPRINKLERS REOD <br />FIRE ALARM REO'D <br />PLANS APPROVED BY <br />onie <br />$ <br />BETBACK <br />C�TY Z�P <br />i <br />CONTACT PERSON AND PHONE NO. <br />/ 1 _ _ I , . <br />I HEREBV CERTIFV THAT I HAVE READ APID EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOtiITY TO VIOLATE OR CANCEL THE PROVISIQNS OF ANY <br />OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAP'CE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF iHIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRA ORS LAW 18.27 RCW AND 296200 WAC. <br />�.� ���. `��C6- IS 9 <br />51GN�iUFE U��k <br />TVPE OF EOUIPMENT �E <br />AIC—/VHNDLGUNIT�H.P. �� <br />FORCED AIR SYSTEMS—B.LU. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />•�. <br />FIREPIACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHEpK NUMBER I FEE <br />�1 ? S!n ? <br />VACANT SITE r�c.� <br />❑ YES ❑ NO BUIL�ING <br />accurarKr xoavxEuixcun�is <br />GNWP pLUMBING <br />BASEMENT 11ECHANICAL <br />❑ YES ❑ N� <br />HEIGNT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIG WORKS <br />LOCAL SALES <br />TAX COOE IS 3105 T0T11L <br />TOTAL S J ' � <br />MIT S � � <br />4L FEE $ . �D I � <br />�u <br />tl <br />� <br />