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�o�- oZ� �E�.LeN►,o;�� Cou�tT, <br /> APPLICATIC� 1 FOR CONSTRUC'T'`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PHINT <br /> HEATING SYSTEM: �GAS O ELECTRIC ❑ _� <br /> BUILDING DtPARTMENT , <br /> 259-8810 <br /> ❑ DEMOLITION ❑ GOMBINATION �] BUILDING �(MECHANICAL �PLUMBING ❑ SIGN <br /> OWNER MAILADDRESS CIN ZIP PMONE <br /> C ,�;�(';�{� p.o. �ox i35`� sn►olrom�ak � wv4 9� q� r yB�--l3�g <br /> TENANT `+ 'MAILADDRESS CIN 21P PHONE <br /> ARCHITECTOflDE51GNER MAILADDRESS CITV ZIP PHONE <br /> �f1,oro NA�mrqN 1b�lS -ll 6�''' � sNa�,on,�o►,�w�- 9Payo u6 �Y�e�d <br /> GE ERALCONTRAfTOF MARRDDRESS CITV ZIP PHONE STPTEUCENSEJ <br /> ��W • 1�a�a1,?" Po. 13ox f356 sn►ol►omitt,��v►�►- 9'8o79i YBs`-/.3�9 Cc� l3�i6*Io7C;� <br /> MECHANICALCONTRRCTOR MAILADDRESS CITV ZIP PHCNE STATELICENSEt <br /> ►�ssoc�iaie� I�Pa�;�» /Y,�3 - NE �93R� W�iUu���, S?35�Oo /}ssOcloZ3 8K7 <br /> lUMBINGC TRACTOR ` MAIL RESS CITV ZIP PHONE STATELICENSEI <br /> C�' � a a I Q ��. 1 w�a �c1y/ �=��aa- C�< Qt��t�iyew <br /> ' � C PACT PRICE OF WOFK <br /> 9 <br /> DESCRI9EWOR ANDSOUAREFOOTAGE VOLVED O � C A TPER�AI:D ONENO� 1 � y g ._13i9_ <br /> r) <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � PROPOSEDUSEOFBUILDING . APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> , ' ���Q1 1[ �q-vr�i 1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS?YPE OF � <br /> � ' � LEGALOESCR IONOFPROPERN(SHOWNB OWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> �/(� � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIVE <br /> � �or—W—v-- BLOCK — Of AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � ' E%y N W' '� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTAUCTION.THAT I AM AUTHORIZED BY THE <br /> � . � � �..�j �s �E ' �QVL, COJ AS OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICFI <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � PARCELTA%I.D.NUMBER C ACTORS LAW 1827 RCW AND 296200 WAC. <br /> :i .'' �, �STHOCTIONLOANLENDER,AUOflESS.TELEPHONENUMBER l <br /> e�,►� � s s 33 w� S /�a`p3 <br /> , � . �� PROJ T ADDRESS � /O/O� ��-j!—��� � SIGN uae osre � <br /> Gtt BUSrtlESS ULENSE NO <br /> � " " PLUMBINCa MECHANICAL <br /> .. � N0. TYPE OF flXTURE OR REM FEE N0. TYPE OF EGUIPMENT FEE <br /> ` WATER CLOSET(TOILEI) � A/C—A/HNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � ' S/ LAVATORY(WASH 9ASIN) � UNIT HEATERS--B.T.U. M � <br /> � SHOWER ' � CLOTHESDRYERS ' <br /> i j KITCHEN SINh'8 DISP � � VENTILATION FAN I <br /> �, � DISHWASHER � RANGE HOOD � <br /> I LAUNDRYTRAY ; WATERHEATER _ ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> � URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> I i DRINKING FOUNTAIN � FIREPLACE IM65AT � � <br /> � FLOOR DRAIN � HEAT PUMP ' <br /> f-�� `� ' BACKFLOW PREVENTERS ; GAS PIPING � <br /> � � , ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> - -SINK(SERVICE—BAIi,ETC.) I � <br /> O � � <br /> � � <br /> - � � <br /> , <br /> SUB TOTAL $ ; SUB TOTAL $ D 'rJ7� <br /> PERMIT $ PERMIT $ —L' <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: S�G � 3��`'7 <br /> � FRONTSETB'CK RE�T�ACK SIDESETBFCK fJ IN�U'' PLANCH CHNl1MBE FEE���� RE EIPT 0. <br /> c(J � " S/ i.° � 3 <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> �5 —� G� ❑ YES ❑ NO euILDING �5 'SU <br /> TVPEOFCONST. N .OFSTORIES atCUPnNtv xo.0i, r,!uNGUxrts � <br /> — A3 I PLUMBING i <br /> S BL FIflESPRINKLEfl5FE0'D BASEMENT � i Q', <br /> '�E9F6 IX'iF f e � MECHANICAL <br /> ��`� 5 V ❑ YES NO <br /> OCCUPANCVLOAD FIREALAFMREO'D HEIGHTIIMITATION ADDITIONALPLANCHECK i <br /> N ' � <br /> Q � OTHER O i (�J <br /> REASON <br /> STATEBUILDINGSURCHARGE i`j D <br /> INiAKE BY PLANS APPqOV�O BY CITY OF EYERETT PUBLIC WORKS D i� <br /> J N LOCALSALES <br /> onre 6 � c33 TAX CODE IS 3105 rora� 7'J J ;�'�, <br />