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APPLIC�►TiO. _ FOR CONSTRdJCT1.iN PERMIT � <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING S'GN <br /> NER ARR DPE55 CitY ZIP PHONE <br /> �{/� � l!y�f/+t{ �1}'�P�° SL`�1-1 ,3�/D /u�H�,rn���'/�'7 �� <br /> TEN_-_SIiT�� MAllA0Di1E55 <br /> AqCMRECTORDESIGNER MAILADORESS CITV ZIP PMONE <br /> GENERAL CANTRFCTOR MAIL ADDRE55 CITV 2iP PHONE STRTE LICENSE� <br /> fAgCMA AL LONTRT idR MAII ADORE55 GITY LP — PHONE — S/tp'�E UCENSE� <br /> T �' ��r���- r -�— _fe��!)/�� -� <br /> PL BINGC TRRCtOR MIILADDR[55 CITY DP PHON[ ' STRi[UGENSC• <br /> CLA55OF WORN� � <br /> NFW ?�ADDITION ALTEfiATION REPAIR DEMOLITION WOODSTOVE�FR�L INSERT BUILDING RELOCATInN <br /> �—� CONTRCT PERSON ANO PHONE NG <br /> ��� �� �^ � � <br /> cor+TaacT aRicE oF wor+r: - ` �lGt.L~C�7 � — <br /> DESLRIB[WORH AND SOUFRE FOOTAGE INVOIVED j <br /> �� <br /> Pao�useoFew�oir+c„ i HEREBV 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 OaDINANCES GOVERNING THIS TVPE OF <br /> LEG OESCR�PTIb170FPnorEarv�sNowNe[�owoanTrncMFouncoaies� yJOAK WILL BE COMPLETED WITH WHETHEA SPECIRFD I'.REIN OR <br /> �oT BLOGH oF NOi THE GRANTING OF A PERAiIT DOES NOT PRE�UNG TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PfiOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONJTRUCTION OR THE <br /> PERFURMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEfl OF THIS PROf'ERTV TO PERFGRM THE WORK FOH WHICH <br /> APPLICATION IS MADE AND ; COIdPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW G 2962 WAC. <br /> /� L!'���j.Y.�.0 / —�1��� <br /> Yi G ,c� 1 G /n.y/- V�i"'�� �—z <br /> - $1G11R111fif �- / U�,L <br /> PHQIECTADDNESS / � . <br /> y- ,;�� � /.q f� � �c rv..aosiuvs3i�a�+sr,�o <br /> PLUMBING MECHANICAL <br /> Np, TYNE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCFD AIF SYSTEMS—B T.U. M E.A. <br /> LAVATORV(WASH BnSIN) UNI7 HEATERS—B.T.U. M <br /> SHOWER CLOTHES DHVERS <br /> KITGHFN SINK 8 DISP VENTILATIOh FAN _�__ <br /> DISH WASHER RANGE HOOU <br /> LAUNDRV TRAY / :NAT�9 H°ATER� <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> DRINKWG FOUNTAIN FIREPLACE INSERT T_ <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREV[NTERS GAS Plf`ING <br /> ROOF DRAINS—RAINIEADERS EXHAUST FPN __ <br /> SINK(SERVICE—BAR.ETC.) — — <br /> �— <br /> SUB TOTAL $ SUB TOT�L 5 /�f ;_ <br /> PERMIT 5 PERMIT S _ /� _ <br /> TOTALFEE $ TOTAIFEE 5 ,�% ;� <br /> FOR OFFICE USE ONLY: <br /> FROHTSETBACK AEPRSETOACN 51�°SETBFCN PIA�< 'iECNNU1dBER FEE <br /> REf,EIPT NO <br /> �.� yy z <br /> usezor+e �otnRen vacaNrSirE FEES VAL'JATION FEE <br /> BUILDING <br /> tVPFOiCONTS.�LLOWRBLE ttPF01LON51.AGiIIA\ ocu.�^�v� xOqVM��^o.u•••` <br /> �ac:o PWM9ING <br /> SZEOFBLDG NOOFSTOPtES BASEMENT MECNANICAL �U <br /> OCCUPRNCYLOAD FIRESPRNN�EiiSREO'D NEIGMTIIMITRTICN <br /> ADDITIONAL PLAN CHECK <br /> SPRINKLER <br /> —T <br /> REAFON FOR SPRINKLEFS <br /> STATE BUILOIMG SURCHAHGE <br /> t <br /> INtAK:BY PLANSAPPROVE�PY CITY OF EYERETT PU61JC WORKS <br /> LOCAL SALES <br /> TAX CJDE IS 3105 TOTAL 7 U ; n� <br />