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;i, <br />APPLICATIQ"1 FOR CONSTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEAT <br />BUILDING DEPARTMENT ING SYSTEM. ❑ GAS ❑ ELECTRIC 1� �/ '�IA,b-F/'in0 —iCSCy� <br />259-8810 <br />[7 DEMOLITION ,D� COMBINATION <br />OWNER MAILADORE55 <br />TENFM / ' <br />� �uu � <br />ARCNITECT Ofl DESIGNEP <br />O BUILDING <br />�t". CITY <br />CITV <br />C MECHANICAL <br />ZIP p4 <br />� • �C/ PM <br />ZIP <br />❑ PLUMBING ❑ SIGN <br />,� �� / �. <br />- - . . , .3�l� 1 <br />titntn iFiqGTOR MAILADDRESS pTV ZiP P ONE S:AiELICENSEi <br />�/� ��,P <br />M1:hGHANICALCONTRACTOfl MAIUDOflESS CITV ZIP PNONE STATELICENSE� <br />PLUMBING�ON7qqCTOR MAllA0DflE55 CITY ZiP PHONE STATELICENSEy <br />__......._ �....�.,...kOW ^� <br />UESCRIB� AqE FOOTAGE INVOLVED <br />PROPOSEDUSEOFBUILDING ' <br />LEGAL DESCRIPTION OF PROPERN �SHOWN BELOW OR ATfAC:' TYO COPIES) <br />�07 BIOCK OF <br />PARCELTAXI.D.NUMBER <br />COIi3fRUCT10NLOANLEN�ER,ADDRESS,TELEPHONE <br />rrre oF FlxT <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />:AUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />ROOF DRAiNS—RAINL <br />SINK (SERVICE—BAR. <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAfl: <br />USE ZONE <br />IYPE OF CONST. <br />NEASON <br />INTAKE BY <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FIRE SPRINKIERS REO'D <br />�x Ss(, <br />FIRE AURM REO'0 <br />(�I�i�� � <br />DATE Z _ <br />BV <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDIM1ANCES CaOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 44 COMPLY WITH THE STATE <br />CONTRACTORS LAW t�7 fl�yW qN� 296200 W fC. <br />� . /1 <br />FEE NO. TVpE OF EOUIPMENT � <br />� A/�A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />T— UNIT HEATERS—B.T.U. M <br />� <br />' CLOTHES DRYERS <br />� VENTILATION FAN <br />� RANGEHOOD <br />; YJATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE (WOOU BURNING) <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUST FAN <br />SIDE SETBACK � PLAN CHkCN Nl1MBER <br />�:FCANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />awra+cr NO.OiVNFIIiNLONitS <br />cxouv PLUMBWG <br />.� _ <br />BASEMENT MECHANICAL <br />❑ YES J NO <br />HEIGHTLIMITATION ADDITIONALPLANCHECK <br />_ OTHER <br />STATE BUILDiNG SUflCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TAl( C6DE IS 3105 TOTAL <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />S3 <br />� <br />a <br />���i3 ; �r� <br />