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� �. <br /> APPLICATIO� FOR CONSTRUCT�ON PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATINCi SYSTEM: U 4AS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> ?59-8810 <br /> I I DEMOUTION I_I COM8INATION �BUILDING I IMECHANICAL I IPLUMBINO fJ SI�N <br /> pWNEq WILADDREfiS CITY ZIP PIIONE <br /> �r�}� go�i�rG co., f?o, 6ox 37��, M�5 ��-7� 5�A-�, w�}• 98r2� 3Yz-sP�l' <br /> TEN�NT M�l DRE59 CITY IIR E <br /> ��E'�NG, Co . <br /> �11CHITELTO(IDE[ANER AU0.�DORE65 // CITY 21P ��KK/E <br /> filE g-uST�N Ca, i/o/-� �/7��, RvE w cE✓�,cs�r, wa. .9Pz�,� 29e-9i�v <br /> OENEMLCONIMCTON 1AARIIWREBf CI ZIP MIONE ST�fELICf1'BEI <br /> /.Pn.. t�=� G�i.V.f l� �Qi4l�� <br /> E�11/UIIC11�CpNiMCTqI GU0.i1DDRC69 � GTY LIP PIIONE ST�(EIICF.NSC� <br /> PLIIMBINOCONiR�Ct7f1 Ml�I/�ODRE88 CITY 21P ''I�d1E BT�TELICEN8E1 <br /> C��j SSOFYIORK � <br /> 1A NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLI710N I I WOODSTOVE/FRPLINSERT I I BUILDINaRELOCATION <br /> I CON/T�CT PERSON/J!O PIqNE NO. <br /> Cp1IMCi VRICE OF WOIY( � Q� ��i(/ '^��/� � 2 � <br /> pE9�RIBEWp11RIU1DBOWREFOOT�AE VED <br /> l�d�rsra,o-N ��ta6 ��- 3G6 -3s"63 <br /> PPOPOSEDUSEOFBUIIDMO i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIB <br /> ����1�.t+/ G.(-OSs��✓�� APPLICATION AwU KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> !EO/�l UE9CRIPTI[l�OF PROPENrv I��YN BELOW OR�iUCN FWH COPIES) PpOVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> . WORK WIiL @F COMPLETED WITH WHETHER SPECIFIEC� HEREIN OR <br /> �ot e�oac oF NOT. THE �FlANTIriC OF A PERMIT DOE9 NOT PRESUME TO OIVE <br /> ' AUTHORITY TO VIOLATt :R CANCEL THE PHOVISIONS OF ANY <br /> � OTHER STATE OR LOCAL UW�i�AUTATINO CONSTRUCTION OR THE <br /> -"— PERFORMANCE OF CONSTNUCTION.THAt I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERfCRM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COM'LV WITH THE STATE <br /> CONTHACIORS LAW 18.27 RCW AND 29820017AC. <br /> --- x��, �'.�...�.-� . /,� ' <br /> a ��� <br /> � PROJECT�ODf1E9C [�U/} �L�T MOM�IME w�c — <br /> �.�Q03 (/l/. �i/}-S/NO 21�, cnrew�nceair,Enscwo <br /> ���Mp MECMANICAL <br /> NO. TtlPE OF Fl%TURE Olt REM FEE NO. TYPE OF EOUIPMENT �E <br /> WATER CIOSET(TOILET) � NC�A/HNDLd UNITS—H.P. � <br /> � BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. ; _ <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M _T_ <br /> SHOWER � CL0T4EEDRYERS ' _ <br /> KITCHEN SINK 6 UISP � VENTILATION FAN _�_ <br /> CISHWASHER � RANOEHOOD '_ <br /> LAUNDRYTRAV ' WATERHEATER ' __ <br /> CLOTHES WASHEH � N'000 STOVE Y_ <br /> URINAL ' AIETAL FIREPLACE 8 CHIMNEY ' _ <br /> DRINKINO FOUNTAIN � � FIflEPLACE INSERT � <br /> � HEAT PUMP ' <br /> FLOOR ORAIN � — <br /> BACKFLOW PHEVENTERS � OAS PIPINO � <br /> qOOf DRAINS—RAINLEADERS � EXHAU57 FAN ' <br /> � <br /> RINK(SEHVICE—BAR,ETC.) , <br /> � <br /> � ' <br /> SUBTOTAL { ' SUBTOTAL S ' <br /> i <br /> PERMIT S � PE9MIT { � <br /> � TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT fiETBACK REM BETB/�CN 810E BETB�CK PLMI CHECN NUMBER FEE RECEAT NO. <br /> 36 a /6 <br /> use xa+e �oTene� i V�CANT 61TE FEEB VALUATION FEE <br /> � � <br /> BUILOM� f�' /L{i_'� �SD <br /> lYMO�CONI6./iILOWMIF I�'PEdCON¢f/iCtUAL � �uaowui�num� '7 � <br /> PLUMBINa � <br /> Q�i o 41C —�"— <br /> � <br /> O�IE(K BLCO. NO.OF 6TORIEB B�SEMENT MECHINICAL � <br /> � <br /> OCCUP�NCY lW) FIRE BPPNIllERB RL(7U IIEIONT LIMITI1110N ADOI110NA1.PLAN CHECN � I <br /> I <br /> �V 6PHINNLEA � <br /> 7C/�:RNIhR.9PRpMLEP9 � ' � ,.� <br /> i SiATE BUILDINO SURCHAROE � <br /> _ � <br /> MUNf 91- PIANS ��o e. CITY OF EYERETT PUBUC WOHK9 � — <br /> � LOCIIL SALES • 7�� � � <br /> TIIX CODE IS 3105 T0T11L �� ` ; � <br />