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APPLICATIG.J FOR CONSTRUCT► JN PERMIT � <br /> TO BE COMPI.ETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION �,`BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MRILADDRE55 � CIN ZIP PHONE � -�.3� <br /> �m ti�v��_�.ba-v:� �-3-ic?S /�/D ��cG�i2/��`'aDlJ��2c,vr..lc� �'779 9�007- - - - <br /> T:NANT MRILADOFESS CITV 21P PMONE <br /> ARCMITrCTORDESIGNER MAII,ApORE55 CITY ZIP PMONE <br /> �'l_t.C. _ ..'(.r4 11ZrJ72�� <br /> GENERAI COKTRACTOF MAIL A�URE55 CITV 21P PHONE STAT[LICENSE� <br /> �c. �S �-•- Co w�rri al o nt.T <br /> MELNAhICALCOkTRACTOP MAllA0DRE55 CITV 21P PMONE STATEUCENSE� <br /> P�UMBINGCONTRACTOR MAIIADDRESS CITY ZIP PHONE STATELICENSEM <br /> CONTRaCT PPICE OF WORN <br /> DE9C�W�K�SOyAREF00�T�GEIN�VO`L�iED f�//p�„IPE�����4�� --�,49• £1/SS <br /> jy �7 N.f�� nviu <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> PROPOSEDUSEOFBUIIDING APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT.ALL <br /> iS1�r1G� l�(,tl2Lr�lN �S'���____. PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS TYPE OF ' <br /> �eca� SGRIPTIONOFPROPE (SNOWNBEL01'OFATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT� BLOGK oF ��r�� // NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> r,'� .�+- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 7y7� S � V•si OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �/1V1�—/ D�l . (h,qL/r�,�5! - OWNER OF THIS PflOPERTY TO PERFOFM THE WORK FOR WHICH <br /> lM� ( rl .//U.r�� ��i lD AppLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PAFLEL TAX I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 8135-DaU-l�0� - O <br /> �CONSTRUCTIJNLOANLENDER�.�A�WR S5. E�L/�PXONE�N�Ur B,E�j/��/ ���/ /]Q Q (� <br /> Gl� '�S� Zr�T' �Y�`YY v� � �'( �f0 V v <br /> Pfl0 CT ADD ESS $1GNAT �..4 24 <br /> . <br /> GiY BUSWEGS ULENSE N0. <br /> PLUMBING MECHANICAL . <br /> ND. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPM1IENT FEE <br /> , 7j WATER CLOSET(TOIIET) � A/C—AIHNDLG UNITS—H.P. ' � <br /> Z BATHTUB � ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br /> LAVATORY(WASH BAS!N) � UNIT HEATE�S—B.T.U. M � <br /> 1 SHOWER ' ' / CLOTHESORYEPS � <br /> 1 KITCHEN SINK 8 DISP � �/. VENTILATION FAN � <br /> ( DISHN'ASHER � RANGE HOOD <br /> LAUNORYTRAY ; WATERHEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; MtTAL FIREPLACE(WOOD BURNING) , � J ' <br /> DRINKING FCIUNTAIN � FIREPLACE INSERT � <br /> T <br /> FLOOR ORAIh � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � ' 'cXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.j ; � <br /> � <br /> � � - <br /> � � <br /> _ U' <br /> ; � <br /> � SUB TOTAL $ r; SUB TOTAL $ ; <br /> PERMIT 5 � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACN SI�ESETBACK PLANCH CNNUMBER FEE RECEIPTNO. <br /> Z S � �- S�,M s • ,S"Z — .3d <br /> usezoNe LOTAFEA VAC NTSITE FEES VALUATION FEE� <br /> _� � 2 �f y� �YES ❑ NO BUILDING q'Jj Z�Z ��/� <br /> iVr;OiLONST. NO.OFSTORIES oCcuPu�cY Ho.aowEwNGUNnS i <br /> � 2 fJA�{ ' PLUMBING ��5 i <br /> I-. ✓ -r <br /> SRE OF BLOG. FIRE SP91VKLERS REO'0 BASEMcNT IAECHANICAL � <br /> Z5,j3'� Sf d V ❑ YES NO //O � <br /> � <br /> OCCUPANCY IOAD FIRE ALAPM REO'D HEIGHT IIMITAT10N ADDITIONAL PLAN CHECK � <br /> O � ' OTHER ��f��1J Q i <br /> FEASON <br /> STATEBUILDINGSURCHAFiGE � ' <br /> U� <br /> INTANE BV PLANS APPROVED B�' � � <br /> CITY OF EIIERETT PUBLIC WORNS 2U, <br /> LOCAL SALES <br /> oATE �� / TAX CODE IS 3105 TOTAL �2��'/��!,J <br />