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APPLICATIC ] FOR CONSTRUCT, �►N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM� �GAS ❑ ELECTR�C ] <br />BUILDING DEPARTMENT ' <br />259-8810 <br />� DEMOLITION Ll COMBINATION BUILDING �( MECHANICAL i_! PLUMBING 1 SIGN <br />O\YNER MAII, AppPESS q y ,,/ ZIP PMONE <br />���� l�.rc�ryr 6�� y o���L%� /��� ��r.ff �� .� - 7,2.r�/ <br />TENFNT MAILADDRE55 CITV ZIP PHONE <br />�RCMITECTOR�ESIGNER AIAILFODRE55 CITY 21P pMONE <br />GEHEflAL CONTRACTOR MNL ApDFE55 CIN 21P PMONE STATE LICENSE r <br />CONTRACTOR MAILADDNESS <br />GONTRACT PRICE OF WORK <br />PHOPOSED USE OF BUILOING <br />LEGAL C`ESCRIPTION OF PROMERTV �SHO� �N BELOW OR ATTACH TWO COPIES� <br />LOT .-- BLOCK - OF <br />PARCERA%I D. NUNEER <br />CONSTRUCTION LOAN LENDER. RD�RESS.'.ELEPNCNE NUMBER <br />PROJECT ADDRESS�3a 9 ��� <br />PLUMBING <br />NO. TYPE OF FlXTURE OR ITEM <br />WATEfl CLOSET(TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAI�NDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK REARSETBACK <br />USEZONE <br />ivPE 0� CONSt. <br />SIZE OF BLDG. <br />OCCUPANCVLOAD <br />RE�S'JN <br />INTRNE BV <br />)dc�J, <br />qTY <br />FEE <br />ZIP PHONE <br />9��� ��'`a. <br />ZIP PHONE <br />I <br />� <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO OE TRUE AND CORIiECT, ALL <br />PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TYFE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTH[R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORh1ANCE OF CONSTRU ION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TH PROPERTY PERFORAI THE WORK FOR WHICH <br />APPLIC IS MAB.� D I COMPLY WITH THE STATE <br />CO ACT LAW 18Z! ANDy6200 WAC. <br />NO. TYPE OF EOUIPMENT <br />AIC-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSEiiT <br />HEAT PUMP <br />/ GAS PIPING „ <br />� <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAI. FEE $ ' <br />$IDESETBACN PL�N <br />IOTAREA <br />NO OF STORIES <br />flqE 3PHINKlERS REO'D <br />FIPE ALARM REO'D <br />PLANS APPROVED BY <br />DATE <br />VACANiSRE FEES <br />i-! YES ��' N� BUILDING <br />occuwvcr xoavx:wxcuvirs <br />�,noua p�U!ABMG <br />BASEMENT �ECHANICAL <br />❑ YE3 i, NO <br />HEIGNT LIAIITATION ADDITIONAL PLAN CHECK <br />OTHEFi <br />STATE BUILDING SURCHARGE <br />CIl"i` OF EYERETT PU9LIC WOFKS <br />LOCAL SALES <br />TAX Cf1DE IS 3105 TOTAL <br />FEE <br />PERMIT 5 <br />TOTAL FEE 5 <br />