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�� APPLICATIt,��l FOR CONSTRUC7 .dN PERMIT <br /> TO BE COMPLETED IN BLACK INK--PL.EASE PRINT � <br /> �--- <br /> BUILDING DEPARTMENT HEATING SYSTEM: G GAS ❑ELECTRIC ❑ <br /> 259-8610 <br /> I 1 DEMOLITION �'COMBINATION �BUILDING I I'MECHANICAL ! I PLUMBING I I SIGN �: <br /> OIWNER MAIIADDREp55 ! �C(I / /^ ZIP PHONE (J ^ <br /> .I��V� � / � ��O„�DR�J�O 7 VI'G �D IIT� I W411,( Z�pHpNE �Z/� / U��/ ��/ <br /> —��� <br /> nRCHITECTOfl OESIGNER MAII ADORESS CITY ZIP PHONE <br /> £�,N'f ��c�TE rrs �9n� � / �� rw�'� F�,l�31L�t��.J �-,.la. 9�1�z.� is <br /> I 3V1IDT�! CJ�"/ MG, DRES'S�OS /1� �(J1 '�L�� IA� YZIPD� �,�,y � SIATELIC ���r � Z <br /> � A.RR �!T �O . <br /> MECH�N�CQCONTRA TOR MAILADORESS f,IfY 21P PIIONE Sf�IELICENSCI <br /> PLUMBIN�CONTMCTON MARADDRESS GTY 2�P PIIONE STATELICENSFt <br /> CLASS OF WOqN <br /> � NEW I_1 ADDITION LI ALTERATION 1 I REPAIH I I DEMOLITION I I WOODSTOVE/FRPLINSERT I I BUILDINGRELOCi{TICN <br /> CANTACT PERSON AND PHONF,NO. <br /> �RA�� 'r- ,q �3�a ��0���90 2�j <br /> DESCPIBF WONN AND 50 ARE FOOTAGE INV LVED <br /> , ��U �J 0 QzLF"' �� � ^$�SS� <br /> PflOPOSEDUSEOFBUILD c i HEREBY CERTIFY THAT I HAVE FEAD AND .EXAMINED THIS <br /> �D l, �jL�J � �F APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> IECUIDESCRIPTpNOFPROPERTY�SHOWNeELOWOflATiA(:NFWHCAPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHIS7VPEOF <br /> . WORK WILL BE COMf'LETF.D WITH WHETHEH SPECIFIED HEREIN OR <br /> �ot e�ocK oF NOT. TI1E GRANTING OF A PERMIT DOES NOT PRFSUME TO GI4E <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER S1�ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEq OF THIS PROPERTY TO PERFORM THE YJORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTHACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��} ��,�. �,.� c�r y�, �,� —� �/z/9v <br /> PflQ1ECTADUPESS J- SicNni � pq�E ��' <br /> � /9 �� � A�AG�. <br /> LITV BUSWESS lKENSE N0. <br /> PLUMBINO MECHANICAL <br /> • NO. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENi FEE <br /> . WATER CLOSET(TOIIEn � A/C—AIHNDLG UNITS—H.P. , <br /> � BATHTUB ; � FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> � SHOWER � CLOTHES DRYERS � <br /> .. KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � qANGE HOOD , <br /> LAUNDRYTRAY ; WATER HEATER � <br /> _ CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ' METAL FIREPI.ACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIFE�LACE INSERT ; <br /> � FLOOR DRAIN � HEhT PUMP � <br /> � <br /> � � BACKFLOW PREVENTERS ; GAS PIPING � <br /> � ROOF DRAINS—RAWLEADERS � EXHAUST FRN � <br /> SINK(SEfiVICE—BAR,ETC.) ; �— <br /> � ; <br /> �_ <br /> - � <br /> i , <br /> ' 1 _ <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE 3 ' TOTAL FEE E � <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBACK REARSETBACK SIOESETBACK PLANCHECKNl1MBER FEE PECEIPiNO. <br /> 3 � a i i�/� � 6 �a€7 <br /> USEZONE LOT�REA VACANTSITE FEES VALUATlON FEE <br /> C3TYg11[�T�OWpBLE _ 1YPEOFC�ACiUAL octu� xo.�UxcuNnS BUILDING ' � \5/��G� <br /> yt� ;jµv PLUMBING --�� <br /> —r-- <br /> SIZEOFBLDf3. NO.OFSTORIES � BASEMENT MECHANICAL —i-- <br /> � � <br /> OCCUPANCYIOAD FIHESPqNKLEflSREO'0 NEIGHTLIMITATION ADDITIONALPLANCHECK T <br /> N• ' �� SPRINKLC-R � <br /> PEASON FOfl SPflINKlERS � <br /> _� <br /> STATC BUILDING SURCHARGE i <br /> IMN(E BY PLANS APPROVED BY CITY OF EYERETT PUBLIC WOflKS y <br /> LOCALSALES <br /> �� ,�z J TAX CODE IS 3105 TOTAL ,�22 �l� <br />