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APPLICATI('-'1 FOR CONSTRUC''filN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMEN7 HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ti4 BUILDING I-1 MECHANICAL K PLUMBING ❑ SIGN <br /> �OWNE MAILAODFE55 CITV IP PNONi <br /> .���� ��'� /3� f.�i' 2 � X '� <br /> T AN MR F�DRE55 � CITY 21P PHONE <br /> �.�; N���,-. ���s �� �.v� t ���� ��e <��1 �g 3�-� <br /> ARCHITECTOR�ESIGNER MAILAODFESS CITY TIP PI:pNE <br /> GENERAL CONT ACT R MAIL pDOflE55 CITY ZIP PMONE STATE LICENSE tl <br /> t�v�, f�-1�,.�- <br /> MECHANICALCONTPACTOF MAIL�ODRE55 CIiV ZIP PHONE STRTELICENSE> <br /> PLUMBINGCONTRACIOR MAILACORE55 CIiY ZIP PHONE STATEIICENSEN <br /> WNTRACT PFICE Oi WORK <br /> a� <br /> �ESCR1BE WO,FK Al�D SOU,ARE FOOTPGEI INVOLVED CONTACT PERSON AND PHONE NO. <br /> llu �� ��eer- � o.. "'� F1ae•' H� F4� <br /> 51 <br /> � w �vtc� <br /> MD� c���S '^� ��°'� � �'` i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING qppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALI. <br /> W� ' L� �0 a10-� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY(SHOWNBELOWORATfACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ' �or e�ocK pF NOT. THE GRANTING OF A PERMII� DOES NOT PRESUME TO GIVE <br /> ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHOiiIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � CONSTRUCTION LOAN LENDER,ADOflE55,TELEPMONE NUMBER w p (� ^` /�� <br /> i\II 11 {t <br /> � PROJECTADDBESS s���E'��� v <br /> o�rE <br /> J <br /> . �. 115i�6 VS g� Euuc�I Pt elI'Jok7 CRY9USINESSULENS[NO <br /> ', PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/C—IVHNDLG 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 /> � SHOWEfl � CLOTHES DRYERS � <br /> _ KITCHEN SINK 8 DISP VENTILATION FAN � <br /> ' DISHWASHER � RANGE HOOD <br /> " LAUNDRY TRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> � DflINKING FOUNTAIN � FIREPLACE INSERT ' <br /> , <br /> - FLOOR DRAIN � HEAT PUMP � <br /> � ` BACKFLOW PREVENTERS ; GAS PIPING ; <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN , <br /> . SINK(SERVICE—BAR,ETC.) ; � <br /> , � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PEFMIT $ � PERMIT $ ; <br /> TOTAL FEE 5 ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACN SIDE SETBACK P�AN CMECN NUMBER FEE PECEIPT N0. <br /> /� <br /> USEZONE I.OTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO eUi�GING � ; <br /> 7YPEOFCOHST NO.OFSTORIES otavpqtv 400rON[lWiGwntS <br /> caou> PLUMBING <br /> i <br /> i <br /> SIZEOFBLDG. FIRESPRINKLERSPEOD dASEMENT MECHANICAL <br /> �,:.i YES ❑ NO <br /> OGCUPP.NCV LOAD FIRE ALARM REO'D HEIGHT LIMITATION A�DITIONAL PLAN CHECK � <br /> OTHEF � <br /> REASON � I <br /> STATE BUILDING SURCHAFGE ; � <br /> INTAKE BY PLANSAPPROVEDBV CITY OF EUERETT PUBLIC WORKS i <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 TOTAL �� <br />