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APPLICATIC"'1 FOR CONSTRUCi'"'fN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEATING SYSTEM: I�GAS O ELECTRIC ❑_ <br />BUILDING DEPARTMENT <br />2s9•6810 <br />❑ DEMOLITION ❑ COMBINAlION ❑ BJILDING f� MECHANICAL <br />D�Eq MALADDRESS ��T�' Z�P FMONE <br />w�� '� J, v��S�,�c�v„s� 2�� s� aylw—� �v� ��z�1 Z <br />� �"^ �� PHONE <br />'ENGNT MAILADDHE55 ��rv Z�P <br />lR�E�C�W���IG�v���<y��'LAD;RE�S`5 O\ �-`"f0 �'`"` L�Y"�� J�\� <br />-� b � <br />�ENEr� LC TR�CTOR MAILADDRESS ��� <br />�r\ ��`iS¢�. . Cl�a\ --1 I.l�,. c�.� Kv. <br />MECNANIG�LCOM7RACTOR MMIAUDRE55 <br />pIUMBINGCONiR�CTOR M�ILADDRE55 <br />CONTRAGT PRICE Of WOQ� K / <br />`.� � � \ Da� ,( <br />FROPOSEO USE OF OURDING <br />LEGAL OESCHIPTION O: PROPERTY I��N BELOW OP ATfACH TWO COF�ES� <br />LOT BLOLK OF — <br />P�RCEL <br />8 <br />FOR OFFICE USE ON�V: <br />FRONTSETBACK � REARSETBRCK <br />7 C 7 <' 7'! <br />TYPE OF CON57. <br />7� <br />PEASON <br />BY <br />FIRE <br />DRTE <br />CITY <br />cm <br />nr <br />0 <br />ZIP <br />ZIP <br />❑ PLUMBING ❑ SIGN <br />.�34� -3k�b <br />��S�k b �z�� <br />PMONE r5T�7ELICEN5E1 <br />3Ss 4'1 4'� <br />PHONE ST�Tf LICENSE I <br />PHONE S7ATE�ICENSEI <br />LONTACT PERSON AND PMONE NO. <br />20� ZS °� — 3� <br />i HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WNETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PflOVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 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 29R.200 WAC. <br />g � �`"�`� �1S \�— <br />sw�u*uaE o�rE <br />FORCED AIR SYSTEMS—B.T.U. <br />UNITHEATERS—B•T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WO00 STOVE <br />METAL FIREPLACE (WOOD BUI <br />FIREPLACE INSERT <br />HE�Q PUMP <br />GAS PIPING <br />SIDE SETBRGK �+" � •' <br />-t.s' ' p� ,c� <br />VAGRNT SITE / �ES <br />C YES /! NO oui�oiNG <br />CCCUV�NCY NO.MPMLLWLIIXIiS <br />^m'° f PLUMBING <br />BnSEMENT �O MEGHANIGAL <br />❑ YES <br />NEIGHi IIMITATlO; <br />ADUITIONAL PLAN CHEGK <br />OTHER <br />STATE BUILDING SURCHAHGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SRLES <br />TAII CODE IS 3105 TOTAL <br />SUdTOTAL <br />PEfiM1T <br />?OTAL FEE <br />�3. C� v <br />% %� <br />U <br />✓ <br />i <br />C.Q <br />