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APPLICATIO`' FOR CONSTRUCT� �N PgRM11' � <br />TO BE COMPLETED IN BLACK INK-PLFqSE PRINT <br />HEATING SYSTEM: �'GAS �..I ELECTRIC �..1 � <br />BUILDING DEPARTMENT , , <br />259-8810 <br />DEMOUTION COMBINATION BUILDING �'`1AECHANICAL i I PLUMBING SIGN <br />.� <br />,��vN.=� i , I.NILAyoREs, . C� � ✓1 , ��r�� � � n":, ,., _ ,P�;��:E � -- , . . ; <br />�LNRNI � � MAI�ADbR[55 CITY <br />ACCNITECTORDESIGNER MAILADDRE55 ��t� <br />G/E-N�E�� T AGIDB M4!LA�HE55 ,_ �� iS�11' <br />�r/�� u �i�� � <br />ME6NANICFLCONTRA�:iOR MAlLAODR[SS CIiY <br />PL�NG�TRACt�� _NAILADORESS CITY <br />5 m:+C <br />CONTRACT PRICE Of WORK <br />�]'�G CR1NA �Q CC{ @ � <br />DESCRiBE WORK ANO SOUAqE �OOTAGE INVOtVED <br />PFOVOSED USE OP BUILDMG <br />LEGAL DESCFiPT10N OF PROP[FiV (SNOWN DELON' OR AiTALH TVJO COAIES� <br />LOT OIC:Y OF <br />PARC[LTA%IO.NUM�[R <br />NO. TYPE OF FIXTUhc vhi'TEM rt� <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ _ <br />LAUNDRYTRAY <br />� <br />CLOTHES WASHER � <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIM <br />RACKFLOW PREV[NTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) � <br />�� �8 TOTAL $ <br />F AMIT $ <br />TOTAL FEE S <br />FOR CFFICE USE ONLY: <br />FNONTSETBACK N[ARSETBACK <br />USE20NE LOTAPEA <br />i\PEOfCONSi NO.OF�;JNIES <br />SIZEOFBLOG FIRGSPRINNLEFSPE�D <br />O('CIIPANCVLORD FlPEN_ANMHEOP <br />REASON <br />INTANEBY PLANSAPPROVEDBY <br />DFiE <br />Z'�P PI�OhIE <br />ZiP V:IONE <br />��'�� �.s9- <br />21P VHONE <br />ZiP PHONE <br />WNTACi PERSON AND PNONE N0. <br />STAT[LIC "� <br />STnTEII� N� <br />STATE LICENSE ♦ <br />I HEREBY CERTIFV ThIAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 9E TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH VJHE7HER SPECIFIED HEREIN OR <br />NOT. THE GPANTING OF A PERMIT DOES �OT PqESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS Of ANV <br />CTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS FROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATIO IS MADE AND I COMPLV WITH THE STATE <br />CONTRAC�RS LRGJ 1�27 RCW AND 296.200 WAC. <br />n:� <br />TYPE OF EOUIPMENT <br />A%C—A�HNDLG UNITS—HP. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS _ <br />VENTILATION FAN _ <br />RANGE HOOD <br />WATER HcATEN <br />WOOD STOVE <br />METAL FIREPLACE IWOOD BURNING) <br />FIREPLACE IhSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />S�DESETBACH PLANCHECKNUMBEPn <br />L �/ln7d <br />VACANT SI1E FEES <br />-. YES �^'. NO BUILDING <br />Wf,p�AYp p90��W(ILiM1�u•!'S <br />e+nu� p�UM91NG <br />BASEMENT MECHANICAL <br />i� YES ��� NO <br />t�EiGHTUMITnTION ADOITIONALPLANCHECK <br />OTHER <br />STATE OUILDING SURCHARGE <br />CITY OF EUERETT PU�LIC \VORKS <br />LOCAL SALES <br />TAX CO�EIS 3105 TOTAL <br />FEE <br />SUB TOTAL 5 �(� ' � <br />PERMIT S /�� <br />TOTALFEE S — � <br />RECEIPT NO. <br />VALUATION FEE <br />� <br />— —y— <br />i <br />� <br />i <br />