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APP�lCATI/rrV FOR CONSTRUCI rON PERIWIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��r���-rs <br />BUILDING DEPAkTMENT HEATING SYSTEM: rj GAS U ELECTRIC ❑ <br />259-8810 <br />DEMOLITION COMBINA'iION BUILDING MECHANICAL �PLUMBING SIGN <br />OWN�R��Y��'^ AILADDRE55 ��l/N� �L2�� PMONEC�S(�_ C/I'/� <br />/�% r � �-ci � <br />J///MS �/��-c <br />OFOESIGNFR MAILAODRESS <br />JNTRACTOR MAILRD�RE55 <br />�.�r , as� <br />LCONTRACTOR MAILADORESS <br />P G ONTFA <br />� �/l.�l'1/� <br />cuss oF woaK <br />I � NEW ��. ADD�TION <br />ASRIL <br />�. <br />GC� � �/�G ��Jc� c t�� <br />CITV ZIP <br />jt� <br />� � <br />LITY ZIP <br />PHONE <br />5�- <br />PHONE <br />�UuIJ V `.+lJ / � �v `(i�IL✓ e�T . ZIP ,�� N� <br />ALTERATION REPAIR � DEMOlITION .' WOODSTOVEiFRPL INSERT <br />I �ONTACT PERSON AN� PNONE NO. <br />AND SOUAflE FOOTAGE INVOI.VEO <br />LEGAI DESCRIPTION OF PPOPERTV �SHOWN BELOW OR ATTACH FOUIi COPIES� <br />LOT BLOCK OF <br />PLUMBING <br />BATHTUB <br />LAVATORV�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR URAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. ETC.1 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 3 <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK REARSETBACK <br />USE 20NE LOT AR[A <br />TVPC Jf LONIS ALIOWABLE IYPE Of CONSI ALiUAI <br />SIZE OF BLDQ NO.OP STORIES <br />OCCUPANCY LOAD FIRE SPRNNLERS REO'0 <br />INTARE BV I PLANS APPROVED OV <br />3 STATE LICFjlG � I� '1 � /' <br />`J <br />� <br />STATE LICENSE • {�+`�/ � /` <br />/v iliL. <br />STATE LICEPBE a <br />j�P�;U�-k /iGLZ <br />. BUILDIVG RELOCATION <br />I H[REBY CERT�FY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDIhANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIPJ OR <br />NOT. THE GRNNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AU?HOR' fY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN3 CONSTRUCTION OA THE <br />PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHOfiIZED BV THE <br />OWNER OF 1'HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LA 18 7 CW AND 296.200 WAC. <br />x '� "t , a 5 9 � <br />S�G441UF[ UAiE . <br />NO. TYPE OF E�UIPMENT <br />— A/C—A'HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />� � UNIT HEATERS—B.T.U. M <br />CLOTHESDRYEFS <br />; VENTILATICN FAN <br />� RANGFHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE & CHIMNEY <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />GAS PIPING <br />� EXHAUSIFAN <br />SIDESETBACK PIANCNECHNUMBER FEE <br />� <br />�5�..�i <br />vncnNr site FEES <br />�UILDING <br />acuanecv xaarnvEuixcuxns <br />cuo:iv PLUMBING <br />BaSEUFNT MECHANICAL <br />HEIGHTLIMITATION ��DDITIONALPLANCHECK <br />SPRINKLER <br />ST>'E BUILDING SURCHARGE <br />CIiY OF EiIERETT r�UBLIC WORKS <br />LOCALSALES <br />TAl( CODE IS 3105 rora� <br />SUBTOTAL $ (� ;S"ZJ <br />PERMIT $ � �/'(J <br />TOTAL FEE $ <br />flECEIPT N0. <br />VALUATION FEE <br />� <br />_ <br />.. i__i <br />�' <br />1�� <br />