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APPLICATIO � FOR CONSTRUCT' 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION CJ COMBINATION <br />OW�NJER MAIL AODPESS JZ T� L,y <br />!Tl7SP �r/ %�'%'L�-rt0'Tl �d <br />TENANT h1AILADDRE55 <br />%e�.ve . � s � w �r�6Y'r" <br />�fR �L/.[ � o ff5 n 7+ <br />RRCHITECTOROE9IGNER MAI�AOORESS <br />MAIL ADOPE55 <br />❑ BUILDING <br />' i.^" GTY <br />crcv <br />❑ MECHANICAL <br />Z�P PNONE <br />Z�P PHONE <br />ZIP <br />❑ PLUMBING �-1 SIGN <br />�7�v3 <br />MECHANICAICONTRACTOR MAILAOORE55 CIiY IIP PHONE STATELICENSER <br />PWMBINGCONTRqCTOfl MAILAODRE55 QTV ZIP PHONE STATEUCENSEy <br />CONTRqCT PRICE OF WORK <br />DESCRIBE WORK AN� SOURRE FOOTAGE INVOLVED <br />PROPOSEO USE OF BUILDING <br />LEGRl0E5CFIPTION OF PROPEPTY (SHOWN 6ELOW OR ATTACH TWO COPIES) <br />�o, " � B�«K oF ASP 19 ��' <br />PARCELTA%IO.NUMBEH <br />�5/A'd? -o0 7 - <br />CONSTRl1CTION LOAN LENDER. A[ <br />TVPE OF <br />LAVATORY�WASH BA; <br />SHOWER <br />KITCHEN SINi( 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTI <br />ROOF DRAINS—RAINL <br />FOR OFF <br />FqONTSETBP <br />� <br />use zor+e I <br />� <br />TYPE Of CONSi <br />�'� <br />SIZE OF BLDG. <br />Z(p/� e <br />OCCUPANCVL <br />� <br />REASON <br />INTAKE BV <br />lOT <br />—000% <br />:LEPMONENl1MBER <br />�P/.0 Y.0 <br />SUB <br />FIRE SPRINKIERS REO'D <br />Nu <br />FIRE ALARM RE00 <br />PLANS APPp01�ED BY <br />J F� <br />onTe i..� / . /� <br />CONTACTPERSON�N�PHONENO. <br />' A <br />79. <br />i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />INORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND t COMPLY WITH THE STATE <br />CONTRACTORS LAW iB.27 RCW AND 296.200 WAC. <br />�-��,�z .���_-._ /o—�v— �'�r <br />ni.n, � �..� <br />NC—IVHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS--B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD I <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />�s <br />M E.A. <br />TOTALFEE <br />o U 6�- <br />FEE <br />�/o �U <br />vacnNrsne - FEES <br />❑ YES ❑ NO BuiLoiNc <br />acuPaxcr xa.aowcwxcuurts — <br />�pOUv pLUMBING <br />BASEMENT � MECHANICAL <br />�l YES VNO <br />HEIGNTLIMITATION ADDITIONqLPLANCH=CK <br />2 � ' OTHER <br />STATE BUILDING SUPCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCALSALES <br />TAl( CODE IS 3105 Tora� <br />5 <br />$ <br />3 <br />FEE <br />H <br />� <br />6� <br />N <br />� <br />