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APPLICATIO" FOR CONSTRUCTr�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />H'ATING EM• G � ` <br />BUILDING DEPARTM" � SYS7 .❑ AS LECTRIC ❑ <br />259-8810 <br />i=] DEMOLITION CI COMBINA710N ��LDING L.I MECHANICAL U PLUMBING ❑ SIGN <br />OWNER �%� MAILpDORESS //J� , C/I�TY n21� PHONE /� <br />� V i ��-'> �� '"I I,U O iC� �� \ �c7 7;' � i"�= �`---_ � 7%l <br />TENA MAIiA00RE55 ..f/ CITY IIP � PHONE <br />] w� <br />l Q ��-��' <br />ARCM CTOROE IGNER MAILAODRESS CITY 21P PHONE <br />GENcRALL.NT9RCTOR MAILA�OflE55 n CITV ZIP PHONE STATELICENSEa <br />�Exr/tf�F3��� �t'/� <br />MECkANICALCONTRACTOP MAILAODRE55 <br />�"':.`�`"�� PWMBINGCONTRACTOR MAIL/,jDDRE55 <br />, CON7RACTPRICEOFWppK��` I <br />I GESCFlIBE WORK AND SOU. RE FOOiAGE INVOLVEO <br />� _Q�t�,_-- �3c�,�� <br />YNOPOSEDBSEOFBWLOING `� <br />LEGAL OESCRIFTION OF PROPERTV �SHOWN BELOW OR ATTACH iW0 COPIES� <br />l0T B�OCN OF <br />y: <br />_�-^'_� /<' ��� <br />PARCELTFXI.D.NUMBER <br />f <br />PLUMBtNG <br />O. TYPE OP FIICTURE OR �TEM <br />WATER CLOSET (T61LET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />K�TCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BpCKFLOW PpEVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FpONT SETBACK REAR SETBACK <br />USE 20NE LOT AFEA <br />TVP���E,,O--F���LONSi NOAfSTORIES <br />� � <br />SRE OF BL�G. FIflE SPRINNLERS REO'D <br />�Z�! • i.�. Ab <br />OGCUPANCY LOAD FIFE ALARM REOD <br />12 ND <br />PlANS APPROVED BY <br />DATE '^//Z/A2 <br />GIIY <br />CITV <br />FEE <br />ZIP PHONE <br />ZIP PHONE <br />CONiACT PERSON AND PHONE NO. <br />STATE LICENSE a <br />SiATE LICEI�SE a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERFIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR6IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFjS LAW 1�27 RCW AND 296.200 WAC. <br />N0. <br />A/C-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATEflS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATFR <br />WOOD STOVE <br />METAL FIREPLACE (WOOU BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFHN <br />SIDE SETBACK PLAN CHECI NUMBER <br />a3J <br />VACANT SITE FEES <br />� YES _�, NO BUILDING <br />OCLU�AN[Y HO OipWEIIINGI1Nii5 <br />�Z �' PLUMBING <br />BASEMENi MECHANICAL <br />Ci YES 'XNO <br />HEIGHTUMITATION PDDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />� <br />.� <br />FEE <br />� <br />� / i <br />)%� ,!�i� <br />