Laserfiche WebLink
� APPLICATIP'�1 FOR CONSTRUCT'`7N PERMIT � <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: � GAS :J ELECTRIC ❑ <br />BUILDING DEPARl MENT <br />259-8810 <br />`J DEMOLITION i; COMBINATION �—I BUILDING ! J MECHANICAL � PLUMBING ❑ SIGN <br />OWNE�R/ MFILADDRESS GITY ZIP PNONE <br />K _ . ._ / D � _�-_/ .�.._„ __._ L, /a OR9�,i 9�','7 _ /-�i'7 <br />pITV ZIP PHONE <br />AFCHITECTOFDESIGNEF MAILAO�aE55 CITV ZIP PMONE <br />s4� F <br />GENEHALCONiRACTOR MAILA�DRESS CIiV ZIP PHONE STATELICENSEM <br />Tiin //�� C <br />MEGMANICALCONTFACTOR MAILADURE55 CITY 21P PHONE STATELICENSEI <br />PLUM01NGnCOYTRACTOR MAILADORESS CITY ZIP PHONE STATELICENSEI <br />SnM� <br />CONTRACT PRICE OF WORK <br />N��J <br />DESCRIBE WORK AND SOUARL FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br />PROPOSED USE O'= BIIILDING <br />LEG�L DESCRIPTION OF PHOPERN �SMOWN BELOW OR ATiACH TWO COP�ES� <br />LOT BLOCK OF <br />PA�T�� �I ER V D I�L <br />CONSTRUCTION LORN LENDER. ADDRESS. <br />PROJECT ADDRESS <br />253Z 19—(l� ST <br />PLUMBING <br />NO. TYPE OF FIXTUI <br />. WATER CLOSET (TOILE <br />BATHTUB <br />�L LAVATORY 1WASH BASI <br />� KITCHEN SINK 8 DI: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW PI <br />SINK <br />OR ITEM <br />FOR OFFfCE USE ONLY: <br />FRONT SETBACN REAR SEiBACK <br />USE ZONE <br />7YPE OF CONSi. <br />S2E OF BLOG. <br />OCCU°ANCVLOAD <br />REASON <br />INiAME BV <br />I HEREBV 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 />WURK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LGCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFdRM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT RS LAW 78.27 RCW AND 296200 WAC. <br />I ���� g A � ��/Z ' /� <br />SIGN UR U�TE <br />FEE N0. TVPE OF E�UIPMEN7 <br />� AI�A/HNDLG UNITS—H.P. <br />� FORCED AIH SYSTEMS—B.T.U. M E.A. <br />; UNIT HEATERS—B.T.U. M <br />CLOTHES DfiYERS <br />. VENTILATION FAN <br />SUBTOTAL 5 � I <br />PERMIT $ � <br />TOTAL FEE $ ' <br />SIDE SETBACK PLAN <br />LO7 AREA <br />NO. OF STORIFS <br />FIRE SFFINNLER$ REO'D <br />FIRE ALARM REOD <br />PLAN�P� OVED �V <br />d <br />OATE , , /.... �n9 <br />VACANT SITE <br />CI YES ❑ NO <br />OLfur'�itv I:OOfDWEllillGuxiiS <br />Gnou� <br />i-i YES ❑ NO <br />HEIGNT LIMRATION <br />CITY OF EYERETT <br />LOCALSALES <br />TAl( CODE IS 3105 <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />PLWdBING <br />MECHANICAI <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUPCHARGE <br />PUBLIC \YOFKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 3 <br />0 <br />