Laserfiche WebLink
APPLICATIQ -�� FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION p'v BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWN ---"" CITY ZIP — PHONE <br /> TENRNT k ROQBf'S Q ighuc�l00 :ITY ZIP 'HONE <br /> Roper Mayi rC•Owner <br /> 4719•118 PI.S.E.Ew� �it,Washington 98208 <br /> :.nCH1TECP BOG�RC7099RD %�T�' Z�P PNONE <br /> NERALCONTRACTOR MAILA��REiS CITY ZIP PHONE /�STATEIICENSEI <br /> CrierS Ci��vsf�unf�a� �719 /I`i �3 ✓�� SE <vei-r71 %f'CS ?'7-/Sh� l�•vr ,�C D?9.P� <br /> M MANICAL CONTRpCTOR MAIL ADDRE55 �ITY ZIP PHONE ST�TE LICENSE I <br /> PWM.B,cINGCONTRACTOR'/ MAILADDRESS CITV 71P PHONE STATEIIGENSE� <br /> G��(/CY �UOYKS f�004i /Y.�.N��• ' Sv �^ •�S S��' <br /> CONTRACT PRICE OF WOflK <br /> �SCRIB�WORN AND SOUARE FOOTAGE INVOLVED �ONTACT PERSON FNO PNONE NO. <br /> �,, �� r✓,�, ,�,,,,� ,� � F� <br /> j i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> /` PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE iRUE AND CORRECT.ALL <br /> '.. � ' i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGpL ESCRIPTIONOFPROPERTV�SMOWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETIIER SPECIFIED HEREIN UR <br /> NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br /> �oT P�°�K °�F AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANV <br /> .�� .!M 1I11 _ �'///1SI�ifM S. � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEAFORMANCE n�CONSTRUCTIOM.THAT I AM AUTHORIZED BY TNE <br /> ?�_ �� � OWNER OP THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> anacEi rnz i.n.r+uueeR CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> " —p — C�o3 �-oOc` <br /> CONSTRUCTION LOAN LENDER.ADDR S5.TELEPHONE NUMBER <br /> Fi-o,u'f,'e� 13a...l1 Na�✓ IEn/�..�<,✓ /�/^C8/ . ��' �" <br /> PROJECT ADD S37(��� sic one <br /> i �.- cirreusrt+essucEHSE � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> oj WATER CLOSET(TOILET) - � A/C-A/HNDLG UNITS-H.P. � <br /> �j BATHTUB FORCED AIR SYSTEMS-B.T.U. M E A. �- <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 TFAY ; WATER HEATER - � <br /> CLOTHES WASHER � � WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP —�- <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOf ORAINS-RAINLEADERS EXHAUST FAN FF7� - � <br /> SINK(SERVICE-BAR,ETC.) � <br /> � ; <br /> � , <br /> SUB TOTAL $ �" SUB TOTAL 5 �' ' - <br /> PERMIT S PERMIT S <br /> TOTAL FEE $ TOTAL FEE S <br /> FOR OFFICE USE ONLY: ' ��� <br /> FRONTSLTBRCN / PEARSEiBACK / SIOES� C �`�� PLANCNECKNOM7BEP� FE� PEGLIPTN00(_ � <br /> � � <br /> usezoNE �ornaen vncnN SRE FEES VALUATION FEE <br /> ��' C� YES ❑ NO �- <br /> BUILDING - /�.�(,` � <br /> TYPFOFLONSi. NO.OFSTORIES aa:�>acr Noc�V+.tui:6uNn5 <br /> �Tl�T— 1°oj° PLUMBING I �L % '�� <br /> �L ' Lt ; <br /> IZEOFBIOs I3t FIRESPRINKLERSPEOD BASEMENT _� MECHANICAI �-C� � <br /> F J i: YES LY NO <br /> 4 o sF G �J"]4 � � <br /> AD�ITIOIJAL PLAN CHECK <br /> OCCIIPANCYL AD FlREALARMREO'D HEIGHiLIM1T�ilON/ iJ , /! '��c"'r <br /> � � <br /> OTHEFi � �� ) � � <br /> REASON <br /> STATE AUIL�ING SURCHARGE ; � � <br /> INTANE BV PLANS APPR�O1VED BV CITY OF EYERETT PUBLIC WORKS J' — / <br /> LOCAL SALES <br /> enTe�J 5, TAX COOE IS 3105 TOTAL � '� <br /> �� <br /> �/� ,1 — . , � _ <br />