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� <br />APPLICATIO"' FOR CONSTRUCT�"`N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEAT'NG SYSTFM: �GAS J ELECTRIC J � <br />BUILDING DEPARTMENT — <br />259-881 C <br />I 1 DEMOLITION I! COMBINATION I; BUILDING �>QfE NANICAL f: PLUMBING I! SIGN <br />01NNEF MAILADORESS CIiY ZIP P40Nc <br />'�u.\;e. �crc�enSP.�� I711 ,��I S1 L�C'.�Clr q�lLO! ?.Stf,L��IS'� <br />iEN6Ni IAAILA�DFE55 dTV ZIa P/IONE <br />ARCHITECTOROESIGNER MAILADOPESS <br />CRY ZIP <br />GENERALCONTRACTOa IAAILADOFE55 CITY ZIP PYONE STATELICENSEa <br />MECHANICALCONTR4CTOR nMAILADORESS GRY ZIP PHOIl= STAiELICEN5E0 <br />%�LQ,r2 CV�^�, r',i�,�oyc 131�� w:N:!?. �f�LiZ �-I}SS'-Z�JL A4���,HC.c�in�^-'i ��Ly <br />PLUMBINGCON'.FACTOR MAILAOOPESS qTY ZIP Pr10NE STATEL:CENSEa / <br />CONiRFCT PFIGE OF WORK <br />G J <br />O DU�� <br />DESCRI9E WORN FND SOUARE POOTAGE INVOLVED <br />R���..,hUT x�� G-u s c;,,-c.. <br />v-�:T` ..tJe.�,J C,-[.�S C.: rC , I-4eu <br />PROPOSEO USE OF BWL�ING <br />LEGAL DESCFIPiION OF PROPERTV �SHO WN EPLOW OR AiIACH TYJO COPI:S� <br />LOT BLOCN OF <br />PARCELTAXI.D.NpMBEF <br />CONSTRUCiIONLOANLENDEq.ADDRESS.TELEP110NEN7MBER <br />PRO� � A! DRES3 `y ST <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITCM <br />WATER C�OSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY7RAY <br />CLOTHESIVASHEA <br />URINAL <br />DRINKING FOUNTAi!J <br />FLOOR DAAIN <br />BACKFLOW PREVENI�ERS <br />ROOF DRAINS—RAINLE,\DERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE i1SE ONLY: <br />PRONT SE7BFCN REAR SETBACK <br />USE 20NE <br />7YPE OF L01757. <br />S12E OF BIDG <br />OGGUPANCYLOAD <br />RE�SON <br />WT�NE �Y <br />n <br />CO4TACTPERSONAN�PMONENO. <br />.,-,;S �:,�y ���_S'•2-J"Z <br />I HEREBY CERTIFY THAT I HA�/E READ AND EXAMINED THIS <br />APPLICATION AND KNqIN THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Or LAWS AND ORDINANCES GOV[RNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF h 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 />PERFOR�IANCE OF CONSTRUCTION. 7HAT I AM AUTHORIZED BY THE <br />OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS�qW 78.27 RCW AND 296200 WAC. <br />�;�.�.�1����� a -8 9s� <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />� AJC—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />; WATER HEATER <br />WOODSTOVE <br />; METAL FIREPLACE I <br />; FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />SUB TOTAL S ; <br />PEHMIT 3 � <br />TOTAL FEE S <br />SIDE SETBACN <br />LOT AREA <br />N0. OP STORIES <br />FlRE SPPINK�ERS REO'D <br />FIAE FLARM REO� <br />PLANS APPROVED 9Y <br />onr� <br />VACANT SITE <br />❑ YES NO <br />IICCOCAqLY IiQO�OW[ILR�GONil6 <br />r,aouv <br />PASEM11EIJi <br />^ YES -i NO <br />ME�GMT LIMITATION <br />CITY OF EUERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 5 <br />RECEIPT N0. <br />FEE <br />� <br />i <br />i <br />i <br />� <br />