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APPLICATION :'OR CONSTRUCTIO� PERMIT � <br /> TO BE COMPLE?t� IN BLACK INK—PLEASE PRINT <br /> BUILDING OEPARTMENT HEATING SYSTEM: GAS O ELECTRIC ❑ �� <br /> 259-8810 <br /> I J DEMOLITION LJ COMBINATION C I BUILDING ,,�I MECHANICAL ❑PLUMBING I] SIGN <br /> OWNER MAILADDRESS CITY ZIP PNONE <br /> ��ti� O�� lo i� AAAPLEST- �J�(��'�' �71�I ZSz-2o�� _ <br /> TENANT MAILADDRESS CIN ZIP PMONE . <br /> ARCNITECTOflDE51GNEP MAILADDRESS GTv 21P PNONE <br /> GENEfLLLCONTMCTOR MAILAUORESS GTY ZIP PMONE STQE��CENSE/ <br /> MECHMlICQCONTMCTOR MAILAODRESS LITY ZIP PMONE ST�ILLICENSE� <br /> EvFi?F,QFE�u Sf "�'/L�'f M�YA'� /G!r e-. M�+/QiuF viG-w �� 98zo� ZSz -�I/� �v��is5�z/.CI <br /> PIUMBING CONTRACTOR M�II ADDRE55 CITY 2R' PHONE STAI[uGENSE� <br /> C MCT�Pf�IC/�DWOWcp, • <br /> �"/..V - <br /> DESCRIBEWORNIWD50UAREf00T�6EINVOLVE�TL /lA� r�� _ CONTACTPENSONANDPHJNENO. <br /> T .r7U G4JO '`� L'7'� Tf/ <br /> fFND ,�/OT" LJP'��- � f�5 <br /> �(Q/� �T� ✓"" "� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ThIS <br /> PROPOS USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE ANp CORR[CT.ALL <br /> �����j� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWOR�TrACHTWOCOPIES� WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED MEREIN OH <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE <br /> �or a�ocK oc pUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUU+TING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITM THE STATE <br /> PARCEI T�X ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAG. <br /> CANSTRlICT10NLWNLENDER./�00RE55,TElEPMONENIMIBEH � �� ,�_/�/ <br /> ��_._ , 1 <br /> PROJECT ADDflE88 ne wrz <br /> O /''1A�'tE S`T. ��r �»�E��KE�t� <br /> P��81� MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM FEE NO. TYPE OF E�UIPMENT FEE _ <br /> WATEH CLOSET(TOILET) � A/C—NHNDIu UNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.0 <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYERS ' <br /> � KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAV ; WATER HEATER � <br /> CLOTHES WRSHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTEHS ; � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � , <br /> � <br /> � ' <br /> � ' <br /> � SUB TOTAL E ' SUB TOTAL S <br /> PE�M:; $ PERMIT S <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: aecEiar ra. <br /> FRONT SETBACK REAR SETB/�CK SIDE SETBACK PLAN CMECK N MBEfl FEE <br /> USE ZON[ <br /> LOTAPEA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> NO-0PSTORIES octuMNtr rroduxRuxcuxns � <br /> TYPEOFCONST. cxav pLUMBING ' <br /> SIZE OF BLOG. FIRE SPRINNLEPS HEO9 BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO ; <br /> ADDITIONAL PIAN CHECK ' <br /> OCCUPANCYLO�D FIPEAURMFEO'D MEIGMTLIMITAiION � � <br /> OTHEH <br /> flEA50N � <br /> STATE BUILDING SURCHARGE ' <br /> INTAKE BY PUlNS APPROVED BY CITY OF EYERETT PUBLIC WORKS I <br /> LOCAL SALES <br /> OATE <br /> TAX CODE IS 3105 TOTAL � <br />