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APPLICATIQ� FOR CONSTRUCT"lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC J _ <br /> 259-8810 <br /> OLITION [] COMBINATION ' I BUILDING i I MECHANICAL i PLUMBING i_I SIGN <br /> T1E MAIL ADDRE55 'l CITV 'ZI-Pl PHONE (� <br /> � + 1 ✓ J WIi ��J -I � � .) � <br /> TENFNT AILADDRESS GTV ZIP PHONE <br /> I"� <br /> .1 0 ..�,N �sb� Ri.r�F-- �cz.,�. w S 5 r ao, <br /> ARCHITECT RDESIGNER MRIL�DDRESS CITV `ZIP� PNONE <br /> GENER�L GONTRRGTOR MN�ApDRESS GITV ZIP PHONE STATE UC[NSE• <br /> MEGH�NICALCONTPRCTOR MAIL�DDRE55 diV ZIP PNOt1E STnTELICEN5E1 <br /> PLUMBINGCONTN�GTOR MAILAD�RESS QTV ZIP PMONE STpTELICENSEt <br /> CONTRIICT PRiCE OF WORN <br /> DESCflIBE WORK RNO SOU�RE FOOTAGE INVOLVED CONiRCT PERSON RND PHONE NO. <br /> F. <br /> i HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS <br /> PROPOSEP USE OF B111L01NG APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEHTYISNO WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> J T NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot r e�ocK 3 0 7 oc Nl��yr� AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> r�,*,�.N OTHER STATE OR LOCAL LAW P.EGULATING CONSTHUCTION OR TIiE <br /> PERFORMANCE OF CONSTRUCTION.ThAT I AM AUTHORIZED BV THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> i PARCEL T C I D NUMBER CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br /> ��53 - 307 -� DO/ � V00 / <br /> ' CONSTRUCTION LOAN LENDER.�DDRE 5.TELEPHONE NUMBER � <br /> ; .�-�- f�s <br /> i <br /> PROJECT A ESS s���• F <br /> IlY BUSME54 LILENSE HO <br /> � PLUMSINfi MECHANICAL <br /> NO. TYPE OF flXTUHE OR ITEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. <br /> . BATH7'UB ; FORCED AIR SVSTEMS--B.tU. M E.A. � <br /> � LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> . SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK&DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD <br /> � LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> ' URINAL METAL FIREPIACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> '�, SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> SUB TUTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> � FRONTSETPACK RE�FSETBACK SIDESETBACK PLANCM;C NUMB�R / FEE REGEIPTNO. <br /> ]I., <br /> C c7C!/ <br /> use zone ior nRen VACANT SITE FEES VALUATION FEE <br /> i� YES �. '� NO BUIL�ING <br /> ttPEOtLONST NO.OFSTOFIES octUvauc xowwrtuixGuu�is i <br /> °B`'� PLUMBING i <br /> SIZE OF BLOG. FIRE SPRINKLERS REO'D BRSEMEN7 MECHANICAL <br /> i i VES i—. NO <br /> OGCUPANCV LO�D FIFE�LARM REOD NEIGHi LIMITATION ADDITIONAL PLAN CNECH <br /> OTHER <br /> REASON �— <br /> STATE BUILDING SURCHARGE <br /> INTAKEBY PLANSAPPROVEDBY CITYOFEYERETT PUBLICWORK$ � <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 ror�� <br />