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APPLICATI� 1 FOR CONSTRtiCT� )N PERM6T � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRiNT <br />��� <br />BUILDING DEPARTMENT HEATING SYSTEM: �GAS O ELECTRIC ❑_ _—� <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ;�MECHANICAL I_7 PLUMBING ❑ SIGN <br />OWNER M�ILq�ORE55 CITY ZIP PHONE <br />t��7y L�NEH�kN 32� �o� :r � �U=i��T `3R'�"j �CZ -d'2�/ <br />TENANT MA�LAOORE55 C.ITV ZIP PHONE <br />ARCHITECTORDESIGNER MAILAO�RE55 CITV TIP PHONE <br />GENERAL CONTRACTOR AIAIL ADDRE55 CITV 21P PHONE STATE LICEKSE � <br />t�2o�A 49NS47I.[NG 2112R 9��=!',,, Lj V�hJNr)� �BOLo 71.;-0`�� cUi�o/Cf/iOc�w <br />tAECHANICAL CONTRACTOR MAIL AODRESS CITI' ZIP PHONE STATE LICENSE p <br />PLUMBING CONTflACTOR MAIL AODRESS CITV 21P PHONE STATE LICENSE p <br />CON f'nAC f PRICE OF VfORN <br />� 3Uo — <br />DESCRI9E WORK ANO SOl1ARE FOOTAGE INVOU Eu <br />{M1. (l� • �iL� <br />PROPOSED �3E O: BUILOING <br />LEGAL OESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH?WO COPIES� <br />LOT BLOCK — OF <br />PARCELTAXI.D.NUMBER <br />CONSTROCTIONLOANLEN�ER.AO�PESS,TELEPHONE <br />TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />LAVATORY(WASH BA: <br />SHON�ER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />9ACKFLOW PREVEN' <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAflSETBACK <br />USEZONE I LOTAREA <br />iVPE Of LONS7. <br />SIZE OF BLDG. <br />OCCUPANCYLOAD <br />REASON <br />INT�KE BY <br />GUNTAGT PERSON AND PNONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIS!nNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEREIN OR <br />'OT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />nUTHC:IITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER ST,\TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. �HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPcRTY TO PERFORM THE WORK FOR WHICH <br />APPLICATiON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 R�ND 296200 WAC. <br />SXIGNRiUI� � OAiE <br />MECHANICAL <br />FEE <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTAL FEE 5 <br />SIDE SET�RCN PLAN <br />NO. OF S fORIES <br />FIRE SPRINNLERS REO'� <br />FIRE ALaF1A REOD <br />PLANS APPflOVED BV <br />DATE <br />❑ YES i:i NO <br />OCCUPANCY NO OfpWiLl�N61.11R5 <br />caow <br />❑ YES ❑ NO <br />NEIGHT IIMITATION <br />CITY OF EYERETT <br />LOCALSALES <br />TAI( CODE IS 3105 <br />A�C—AIHNDLG UNII'S—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHESDRYERS <br />VENTIL4TION FAN <br />RANGEHOOD � <br />WOOD STOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />PUBLIC WOqKS <br />TOTAL <br />FEE <br />SUB TOTAL 5 <br />PERMIT $ <br />TUTALFEE $ <br />qECEIPT NO. <br />