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APPLICf�TIC l FOR CONSTRUCT�"'fN PERMIT(� "���� <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �i�.Err <br />BUILDING DEPARTMENT � HEATMG SYSTEM: .J GAS U ELECTRIC ❑ <br />259-8810 � � <br />f I DEMOLITION ] COMBINATION r7 BUILDING !7 MECHANICAL ll PLUMBING !' SIGN <br />CONTRACTOR <br />CONTRACT PqIC <br />0[SCRIBE \VORN <br />MqIL AODRE55 <br />ADDRE55 <br />t <br />J� <br />:WOLVED <br />�1��C ,; /1lUff <br />PROPOSEO USE OF BUIlOING <br />LEGAI. pESCRIPTION OF PROPERTV ISNOWN OELOW OF ATTqCM T\YO COPIESI <br />LOT D�p�N OF <br />PAIICEL TA%I <br />� ENDER 1�DRESS.IELEPI/ONE NUM�ER <br />WATER <br />SHO�"ER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAU�DRY TfiAY <br />CLOTHES WASHEH <br />URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR ORAIN <br />RS <br />lY�I:J <br />F�OR OFFICE USE ONLY: <br />iRONTSETBACN REAq5E1dACK <br />JSEZONE LOTAfiE1 <br />iVP[O�LONSI M1'O OP STORIES <br />SIZEOFBLDG. FIRESPRMKLEPSflE�'D <br />OCCUFANCVLOFO iIREnLAnMfI[00 <br />REASON <br />INTAKEBV P:ANSFPPROVEDPY <br />� on,c <br />CITY Z ) �.Jj f'MONE <br />CITY ' P � `� PNOry[ <br />pTY ZIP PH('-NE <br />CONTqGTPER50NANpPHONENO.% . <br />$IFltll NJtP <br />^ D ��� <br />STn E UCENSE r <br />S7ATE LICENSG � <br />l'o�Dc./� 3�}a -�/l� <br />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 AN� ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GiVE <br />— AUTHORITV 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 6Y TIIE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION ADE AND. COMPLY WITH THE STATE <br />CONTRACT LAW 18.27 RCW D 296.200 WAC. <br />ZZ � <br />s�cr�.rune wic — <br />Cu u5i4ES51iCCNvF.NO <br />MECHANICAL <br />NJ. I TYPE OF E�UIPMENT FEE <br />A/C—A/HNOLG UNITS—H.P. <br />rORCED AIR SVSTEMS—B.T M E.A. <br />UNIT HEATERS—B.T.U. <br />CLOTHESDRYERS <br />VENTILATION FAN � <br />RANGEHOOD T <br />' WATER HEATER � <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNINGI <br />FIREPLACE INSERT <br />HEAT PUMP <br />' GAS PIPING <br />SiDESETBACH PLANCMECKFUMBER FEE <br />L�U' 7 7 � <br />vacirrtsrte FEES � <br />❑ YES . NO BURDING <br />�pPANCY M11 O�OWfII�HLI1Ni15 <br />unou� pLUMBING <br />UnSEMENi MECHANICAL <br />i7 YES :,� NO — <br />NEiGHTuldliniloN �DDITIONA_ PLAN CHECK <br />OTHER <br />STATE BUiLDING SURCHARGE <br />CITY OF E1�ERETT PU6LICV/ORNS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTPL <br />ITAL 5 //(/ ; <br />f 5 �I <br />FEE 5 �� <br />FEE <br />i— ' <br />