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APPLICATi�fi''f FOR CONSTRUCT'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />l-,r ! l�q—nl N38 Sa's'+F5^.SrJ F7/c�'cTi n�+zo3 ZSZ' 53�3 <br />TENANT MARADDRESS CITV ZIP PHONE <br />ARCXITECTOHDESIGNER MAILAOORESS CITV ZIP PHONE <br />GENERALCONTflACiOR MRILADDRE55 CITV ZIP PHONE STATELICENSEtl <br />MECHANICALCONTH�CT09 MAIL�DDRESS CITY ZIP PHONE ST�TELICENSEi <br />PLUMBIN�CONTFACfOR MAILADDFE55 <br />CORTRACT PPICE OF WORK <br />%� <br />DESCRIBE WOHK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEGQ DESCRIPTION OF PflOPERTV �SHOWN BELOW OR ATfACH TWO COPIES) <br />LOT BLOCK OF <br />'� PARCELTAXI.D.NUMBER <br />CONSTHUCTION LWN LENDER. A�DPESS. TELEPHONE NUMBER <br />PROJECTADDRESS <br />I �13Si .-�, '� Sr. s� <br />� N0. TYPE OF Fl7I7 <br />i WATER CLOSET (TOII <br />i _ BATHTUB <br />LAVATORY (WASH BA <br />SHOWEP <br />�, KITCHEN SINK 8 DISF <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />i BACKFLOW PREVEN' <br />fl00F DPAINS-RAIN <br />i <br />- SINK (SERVICE-BAR <br />i <br />, <br />FOR OFFICE USE ONLY: <br />� FRONT SET&1CN REAR SF.TBACK <br />, USE ZONE LOT AREA <br />PERMIT $ <br />� TVPE Of CONST. NO.OF STORIES <br />� SRE OF BLDG. FIRE SPBINKLERS flE0'D <br />OCCUPMCV LOAD fIRE MAflM REO'D <br />REASMI <br />DATE <br />B .EI/.FiCi�TT <br />CITV ZIP <br />-, , �'��i� .:�7(i�/�p <br />PHONE STATE LICENSE t <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNON' THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />Y�ORK WILL BE COMPLETED WITH WHETHER SPECSFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAN� REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRLiCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTI' TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT.fiiS LAW 1827 RCW AND 296200 WAC. <br />A/�A/HNDLG UNITS-H.P. <br />FOHCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACK PLAN CHECK NUJ�/BER FEE <br />3�1 <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDINCa <br />JLCIIPANtY NO OfUttIlMGI1Wf5 <br />�pWv pIUMBING <br />enSEMENT MECHANICAL I <br />❑ YES ❑ NO - <br />MEI6HTLIMITATION ADDITIONALPLANCHECK � <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FEE <br />i <br />1 <br />� <br />q <br />H <br />