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- APPLICATIC"'1 PFOR CONSTRUCT'�1N PERMiT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS LECTRIC U._ � <br />BUILDING DEPARTMENT <br />259-8610 <br />❑ DEMOLITION !. I COMBINATION ��UILDINC? ! i MECHANICAL ! i PLUMBING L� SIGN <br />OWNEF MyILADDflE55 CITY ZIP PHONE j7s_ Z� j� ny <br />%D�✓/l/L�LI/FS�/�/6 /1E/u�ii�✓��—�P�ST�iii� ��/>lf�i'�r�`J2,� /�?—'�C/6 _ <br />TENANi '/�MAILADDRESS CIiV' ZiP ' � PNONE / <br />AFCNITECTORDESIGNE�� MA�LAJDf1E55 CITV ZiP PMONe <br />.��5/ 6�7/ L /yE5 /�v;.� . �/ 9/S /j,t�,0/.S; iv/t!/�iQE7r" GUA`��c?� -.�'/G /�'S? -� � 3% <br />GENEFALCONTHACTO� MARADDHESS CItY 2iP PHONE i$TATELIC SEY n��-�� <br />yi,n -STf)•!� �'U/U s-To46l�'7�l1ti128 a-8�"sF i.'�/f.9�?� � 3; ds� .-.v,�- <br />MELNANiGALWNTRFGTOR MAILRODRE55 ..ITY ZIP/ PH01 ST�T ICENSE� <br />PLUMB�NGCONTRRCTOR M/ILAppRESS CRV ZIP PHONE STRT[UCENSE/ <br />CONTqRCT PPICE OF \VON . f�'S� �— �3/S /C D <br />pESCRIBE WORN AND SOUARE FOOTAGE INVOLVEO <br />/I/�'GU -1�i��LEX Jz <br />v oseo use oc aw�oir+r. <br />��-si,v��7i,v,t <br />LEGAlOESC IPTION OF PROPERTY ISMOWN DELOW OR <br />�47 BLOCK - OF — <br />PARGELTA%ID NUM9ER <br />CONSTRUCTIONIOANLENDEN.ADOFE55,TELEPN <br />PROJECTADDRESS <br />s a�s-�r, s�T,��v.E <br />PLUMBING <br />N0. TYPE OF FIXTURE OR <br />WATER CLOSET(TOILET) <br />BATHTU6 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />7 KITCHEN SINK 8 DISP <br />URINAL <br />DRINKING FOl <br />FLOOR Di �AIN <br />BACKFIOW PF <br />FOR OFFICE USE OkLY: <br />FRONTSETBPCK FE�FSET <br />ZO � � <br />❑SEZONE LOTAPFR <br />� � <br />fVPE OF LON57 NO.OF ST <br />9Z OFB� FlRESPR�t <br />2�'72 S �„wc <br />OCCUPANGY I C:.J FIRE ALAR <br />�NTAKE OY <br />UAiE <br />NUMBF:H <br />- / LI�T�- <br />SUBTOTAL 5 _5 <br />PERMIT S <br />TOTALFEE S <br />' / 5!DE SETBAJ / <br />REO'D <br />CONTACT PERSON AN� PNONE N0. <br />.�/.J G/Jv�r� <br />�eP i1�J/�/!/ L /./JES7 ��� J-S�CJ/(� <br />i HEREBV CERTIFY THAT I HAVE fiEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMc TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER iPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NO"� PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIiIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />:ED AIR SVST <br />H[ATEFS-8. <br />HESDRYERS <br />�ILATION FAN <br />3E HOOD <br />WOODSTOVE <br />METAL FIFEPL <br />FIREPLACE IN; <br />HE�T PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLANCHEGK <br />.7 YES ' NO tlUIL01NG <br />occv�avcv uoo�ov.aune��.�is <br />^�'_'� PLUMBING <br />BnsE�,i� MECHANICAL <br />.✓�'ES ,_. NO -- <br />HEIGNT uMirnTiON ��DITIONAL PLAN CHECK <br />� / OTHER <br />STATE BUILDING SURCHAfiGE <br />CITY OF EGERETT PUBLIC VJORKS <br />LOCAL SALES "--" <br />TAX CODE IS 3105 10TAL <br />FEE <br />B.T.U. M <br />M <br />PERMIT $ <br />TOTAL FEE 3 <br />FEE FE PTNO <br />�� �L' �%ZZC;C' <br />VAIUATION FEE <br />-13! Zv `'� ; ��: <br />i <br />� � <br />�� � <br />�� � ,r ; � <br />J 6�/ i <br />�T-� <br />' �) (i� <br />"� �. i � <br />