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APPLICAi1C'1 FOR CONSTRUCT"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT f�EATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />OVMER MAILADDRESS CITV ZIP P'10NE <br />ARCHITECT OFi DESIGNEN <br />GENERQCONTRACTOR MAIIADORESS <br />�a+� ( %cr�e,� ConS'�.1 <br />MECHANICALCONTRACTOR MAILADDR 55 <br />PLUMBINGCONTRACTOR MAILADDRESS <br />�� T`RACT PRICE OF WO��iM,l <br />V,�/�iG'U <br />OESCR E WORK ANO SOU�RE FOOTAGE INVIX.VED <br />�—E <br />:+� <br />E <br />BICCK .+-/�-'—�- OF � <br />n i] n , i <br />TAI( I.D. NUMBER <br />�� —nnu_ <br />N0. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEHS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />CI!Y <br />�L �' ' ��O�TV. <br />� ; .kQs <br />UTV <br />cm <br />� � ra �-f � <br />. � _ <br />ZIP <br />ZIP <br />ZIP <br />� <br />ZIP <br />PHONE <br />PNONE <br />� <br />PHONE <br />PHONE <br />CONTACT PER$(;N AND'HONE NO. <br />ST�TE IICENSE I <br />LL< <br />STATE LICENSE • <br />ST�TE LICENSE � <br />� r I HEREBY �ERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT JN AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIf,NS OF LAWS �1ND ORDINANCES GOVERNING THIS TYPE OF <br />IATTACHTWOCOPIES� WORN `�/ILL BE COMPLEIED WITH WHETHER SPECIFIED HEREIN OR <br />`�ho r NOT. - HE GRANTING OF A PERMIT DOES NOT !'!7ESUME TO GIVE <br />AUT;'10RITY TO VIOLATE UR CANCEL THE P�iJVISIONS OF ANV <br />� n OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br />PEPFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TFIE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COy�RACT RS W 18.27 RCW AN 296200 WAC� <br />� y� _ C� <br />NUMBER J <br />� �. a�. � � � /'7� � <br />TOTAL $ <br />�11T $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETB/�CK <br />115EZONE LOTAREA <br />TYPEOFCONST. NO.OFSTORIES <br />SRE OF BLDG. FIRE SPRINKLERS REO'0 <br />OCCOPANCY LO�D FIRE AURM REOD <br />INTANEBY I PLANSAPPROVEDBY <br />DATE <br />0 <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAl1ST FAN <br />NUMBER <br />VACANT SITE rees <br />❑ YES ❑ NO BUILDING <br />acuvwcr xa.aowmi�uxirs <br />c"0�P PLUMBING <br />BRSEMENt MECHANICAL <br />❑ YES ❑ NO <br />HEIGH7uM1inTION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBIIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAL FEE $ ' <br />RECEIPT NO. <br />VALUA710N FEE <br />i <br />i <br />� <br />i <br />i <br />i <br />� <br />i <br />� <br />1 <br />� <br />