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APPLICATIQ"' FOR CONS�RUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS � ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />i_', DEMOLITION Ll COMBINATION ❑ BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN <br />OWNER M�IL �DDRE55 GITY ZIP PHONE <br />�lAt>�i5 L�rzA�� S�/D C�a t�� ��crzr- ��3 a�-a83o <br />TENRNT MAILADDRE55 GITV 21P PMONE <br />RRCHITECTpRDESIGNER M4ILADORE55 GITV ZiF PNONE <br />GENER�LCONTRACTOR MRILAD°� 55 GITY 21P PHONE STATELICENSEI <br />U��r� /�rrfv�uLC�s rc7 �x A?3� El�..�� �1'g� �SS-SS�Y� (/.ar�e..¢o86'PM <br />MECHANIC�LCONTRACTOR MRILADDRESS CITY 21P PNONE STATELICENSE� <br />PIUMBINGCONTR�GTOR MAILAD�RE55 CITY 21P PHONE STATELICENSE� <br />CONTR�LT PRICE OF WORK � <br />5�a� � <br />oFSGRiBE WORN AND SIX1�RE FOOTAGE INVOLVED � � CANTACT PERSON ANO PNONE NO. <br />PROPOSED USE OF OUILDIN6 <br />LEGAL �ESCRIPTION OF PROPE <br />L0T BIOCK <br />PRRCELTAXID.NUMBER <br />CONSTPUCTION LMN IENDER, <br />UUNDRY <br />CLOTHES <br />DRAIN <br />FOR OFFICE USE ONLY: <br />FRONLSETBACN REpR: <br />USE 20NE LOT RF <br />iYPEOFtONSi. NOAF <br />BEIOW OR ATfRCN TWO COPIES) <br />— OF — <br />TELEPMONENUMBER <br />SUB TO' <br />PERMIT <br />SIZEOFBIDG. FIRESPRINKLERSREO'U <br />OCCUPANLYLORD FIREALRRMREOD <br />RERSON <br />INTAKE BV P�ANS RPPROVED BY <br />onte <br />SIDE <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7VPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT 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 AUTHOHRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />��.,. �_�7 iy <br />5�' ATUHE —OA E <br />FORCED AIR SVSTEMS—B.T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTIIATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BUI <br />FIREPLACEINSERT .(oS3. <br />FAN <br />NllA18ER � iEE <br />❑ YES ❑ NO BUILDING <br />acuvexcr xoaowEu�swuxrts <br />�°av PWMBING <br />BASEMENT MECHANICAL <br />u YES � NO - <br />HEIGHT LI�IITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAFGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SIILES <br />TAX CODEIS 3105 ror�� <br />FEE <br />b <br />� <br />�N <br />Y <br />