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APPlfCAT10_ . FOR CONSTRUCT�`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: 0 GAS ❑ ELECTRIC ❑ _� <br />BUILDING DEPARTMENT <br />259-8810 <br />f� DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING i-1 SIGN <br />GMNNER MAILAODRESS. „ . � ^ CITV �, ZIP ^ n � .. P✓ l E I. .J � � . /i7 . . <br />fiio� <br />ARCHITECT OF <br />GENERRLCON' <br />MAIL AODRESS <br />MAIL A�DRESS <br />�� <br />MAIL ADDRESS <br />CONTRACT CE OF WORN <br />� �50c� <br />DESCRIBE WORK AND SOURRE FOOTAGE INVOLVED <br />PROPOSEO USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPEPTV (SHOWN BELOW OP ARACH TWO COPIES) <br />LOT BLOCK OF <br />�i ,� #� /� 1.1C . -� �%i <br />PAPCELTA%L�.NUMBER <br />iON�TRUCT�OH �OA � NDEfl. hf1BSiE55, T� <br />J r�( �� 1 <br />PROJECT ADD ESS <br />PLUMBING <br />N0. TVPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH 9ASIN) <br />SHOWF.R <br />KITCNcN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVEN' <br />ROOF DHAINS—RAI� <br />SINK (SERVICE—BAF <br />SUB TOTAL $ <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGN REARSETBACK <br />USE ZONE LOT 4REA <br />TVPEOFCONST. NOAFSTORIES <br />SIZEOFBLDG. FIRESPRINKLERSflEO'D <br />O[:CIIPANCV LOAD FIRE ALARM REOD <br />REASON <br />INIAHE �Y <br />onre <br />BV <br />CITV <br />CITY <br />�, <br />cirr <br />FEE <br />21P <br />ZIP <br />21P <br />� <br />ZIP <br />CONTACiPERSON <br />PMONE <br />STATE LICFNSE � <br />STATE IICENSE � <br />C CrL-'TH <br />STATE LICE"ISE � <br />0(�7-0lol�(c� <br />i HEREBY CERTIFY THAT I 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 />WORK 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 PflOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Y�D�-�D���..���r 9-�-9�/ <br />5 o�iE <br />N0. TVPE OF EOUIPMENT FEE <br />A/C—FUHNDLG UNITS—H.P. �i%�h <br />FORCED hIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M /�iJ� <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 />EXHAUSTFAN <br />SIDE SETBALK � P�AN <br />i J YES ❑ N� BUILDING <br />OCCUPANLV N00°PMFllIA6U4115 <br />r,Aouv PLUMBING <br />BASEMErvr MECHANICAL <br />[1 YES ❑ NO <br />NEIGHT LInuTAT10N ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFlCHARGE <br />CITY OF EYERETT PUBLIC WORHS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />RECEIPT NO. <br />� <br />�N <br />O <br />