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APPLICATI�`�'1 FOR CONSTRUCT'")N PERMIT �✓� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: �GAS � ELECTRIC ❑ _= J <br />BUILDING DEPARTMENT � — <br />259-881p <br />J DEMOUTIOk ❑ COMBINATION C_i 9UIL OING i I MECHANICAL ❑ PLUMBING ❑ SI�,N <br />��4� � ��I..J1Y"�7MAILA Dp qE J / � V' �U � 1 �Y ZIP /V `i�� P�U" _ /��� _ <br />!1 � <br />-/ "'�\ <br />(.�li <br />TENANT MAILADDRE55 CITY ZIP PMONE <br />ARCHITECT <br />0 <br />S �%roN 23 <br />MAILADDR SS <br />� �s Z�SS 1 � �1 <br />AIL ADOFESS <br />� �s�,3ox �T5 <br />MAILADDRESS �� <br />� n.. � ..9 ! <br />���i�.64`)� <br />JESCRIBE W RK AND SOUARE FOOTAGE INVOLVEO <br />"L �s� 3Lat qG.rc.c� <br />PROPOSEU USE (iF EUILDING <br />LEGAL DESCRIPTION Of�pq01 <br />1' QTY <br />CITY <br />'__ � <br />f <br />R� 6 Y^ ` <br />V'NB�OR� �OCOPIES) <br />� , <br />—174 Sw �'S �, <br />PARCELTAY.I.D.�UMBER �I���r�(L�O����.(�/�('\n <br />"w �..,�, � <br />CONSTRUCTION LO�J L' Efi A�RES�T�j�H�,'` NU,AQB� , I�, (\I <br />B('Ik.�:W ` �ob [5 I 1 N c` Y <br />PRWECLA_ pp€ $ SL#S� .SLti <br />�L/f0�� <br />TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHT� <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK S DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—P.AINLEAC <br />SINK (SERVICE—BAR, ETC <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETB 4 :7EAflSE1BACK <br />� O�A�6PG� <br />USEZONE LOTAREA <br />TYPEOFCONST. NO.OFSTORIES <br />_,J Z <br />S�E OF FIRE SPRINKLERS REO'D <br />O� S� t <br />9 SF Ga�t � <br />OCCUPANCY IOAD FIRE ALARM REO'D <br />a � <br />REASON <br />INTAKE BV PLANS AP�ROVED BV <br />DATE <br />FEE <br />, IJ� g�373 5�0� 9�OL <br />�P -/�N./3 6PpU� /�N ST�IV^��Nn^- <br />ZIP PHONE STATE�If,ENSE+1 <br />n3 �3-o�S`I <br />IZm�/+V��/�. IQ�.� / Z �']�/'�) pTE LICENSE p <br />I HEREBY CERTIFY THAT � HAVF flEAD AND EXAMINED 'fHIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC"i: ALL <br />PROVISIONS OF LAWS AND ORDINA�CES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TC GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR�.IANCE OF CO�STRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS AW 1 27 RCW AND 296200 WAC. <br />xl—�—wG��- �-�9�1� <br />SIGNATUPE OAiE <br />LITY BUSMESS I�CENSF NO <br />MECHANICAL <br />JO. TYPE OF E�UIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT HEATERS—d.T.U. M � <br />� CLOTHES DRYER;> ' <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) ' <br />FIREPLACE INSERT � <br />HEAT PUMP ' <br />GAS 'IPING <br />EXHHUSTFAN / � <br />siue seroncn / ���•`� / / TCJ <br />VACANT SITE fEES <br />G YES ❑ NO BUILi`ING <br />acursxcr iro.orow[wncuHrts — <br />wouv pLU1�1BING <br />re -3 1 <br />BASEMEN7 �� � MECHANICAL <br />❑ YES L'YNO <br />HEIGH7 TION ADDITIONAL PLAN CHECK <br />/ <br />OTHER G�� /L— <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 />s�. a � <br />RECEIPT N0. <br />'7 73 ias�(T3 <br />VALUATION FEE r <br />�3 OZ1 03 " <br />�— i <br />iG <br />— , <br />� <br />� <br />�� <br />i` <br />i <br />� iC <br />, <br />i� <br />i` <br />�O� <br />/�h�/ �< <br />