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-- 9 35 <br />APPLICATIC �f FOR CONSTRUCT''')N PERMIT �✓�'' <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEATING SYSTEM: GAS ❑ ELECTRIC L� — I <br />BUILDING DEPARTMENT <br />259-8810 <br />L DEMOLITION ❑ COMBINATIQN �UILDING '=1 MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL ADORESS CITV ]IP PHONE j <br />OWNER _. _ .. . n—.SF _ .., s� _ on .. .. L CY/1/1� / L/�-Z�i�._. <br />CII'! 21P PNONF <br />ARCHITECT OH DESIGNER MAII ADORE55 <br />-- ��TY Z�p PHOYE <br />�Z L �J2�' CIN ZIP PNONE STATE LICENSF r <br />GENERALCONTflAC�T�OR( MAILADDRE55 ���/r/�/L�'� <br />��iL� �W �"li�v — --_._- <br />MECHANICALCONTRACTOR MAILADDRE55 <br />CITY ZIP PHONe S iA7E i ICF.NSE M <br />PLUM9INGCONTRACTOR MAILADDRESS <br />CITV ZIP PHOHE STPTF. i ICENSE N <br />CCNT.•1ACT PRICE OF WORK <br />oEscaieewonn9qoso�u'nA� T�n���r'�:�n. <br />�1/(�7 L' — <br />, � 9,- <br />USE OF BUILDING <br />LEGAL CRIPTJON OF PROPERN ���•• � 9ELOW OR� PGH lyy� ��n� .II <br />! i I �'��rL4r <br />�o� ��-•r BLOCK <br />'�i'i� �R.6T.G�.S %�i�✓. � — <br />. _ _ . . %,. _ \ <br />CONSTflUCTIONLOAN <br />- �iU`i -Uc.c.�v <br />IDER. AODRESu, TELEPHIXJE NUMBER <br />�,� ���.-� c�7� <br />PE OF flXTURE OR ITEM <br />OSET (TOILET) <br />STD <br />(WASH BASIN) <br />iINK & DISP <br />1ER _ <br />TRAY _ <br />DRINKING FOl <br />FLOOR DRAIN <br />ROOF DRAINS- Rf�INI <br />SINK (SERVICE--EAFi, <br />FOR OFFICE USE ONLY: <br />fFONT SETBACK _ / FlEAR SETE <br />�/J 1 <br />USEZONE� �� A"-^ <br />TVPEOFCONST. N��G <br />SIZEOFBL�SF � <br />3�� 5f G� <br />OCCUPANCVLOAD <br />PEASON/� <br />INTAKE dY <br />�> - 8'JSf's <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISI7NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OF <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 LOCP.L 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 296.200 WAC. <br />Gir ousixess u�cre= rv. <br />MECHANICAL <br />FEE NO. n'PE <br />, qIC—A/HNDLG � <br />� FORCED AIR S1 <br />, UNIT HEATERS <br />� C�OTHES DRYI <br />; VENTILATION F <br />� � RANGEHOOD <br />� � VHATER H'eATEI <br />, WOOD STOVE <br />� � METAL FIREPL <br />; FIREPLACE IN: <br />� HEAT PUMF <br />� GAS PIPING <br />. FXHAIJST FAN <br />SUB TOTAL 5� <br />pF(iMIT 5 ' <br />TOTAL FEE � � <br />�I SIDESE �K f / <br />FIRE SPPINKLERS REO'0 <br />FIRE ALARM <br />PLANS APPROVED BV <br />J �� <br />DATE � /'j„/ /CJ <br />EMS—B.T.U. M <br />T.U. M <br />. p � <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />p�J'APANLY NOOf�WELUNGOHIiS <br />,� / PLUMBING <br />BASEMEN7 MECHANICAL <br />❑ YES j�NO <br />MEIGH7uMlinTlor+ ADDITIONAL PLAN CHECK <br />Z5 � OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 Torn� <br />0 <br />TOTAL FEE $ I UlJ I <br />PECEIPTNO. n <br />3v �os�� � <br />VALUATION FEE <br />Z ls �� /D�` <br />i� <br />, <br />I <br />/��� i <br />� <br />� <br />� <br />