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APPLICATIQ^: FOR CONSTRUCT.'-lN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />I HEATING SYSTEM� ❑ GAS 0 ELECTRIC ❑ I <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING LkN1ECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN°R MAILADDRESS CITY ZIP PHONE <br />.3TFdd f��i�!'Y�CE �'b9 � � EVERE.7'T �16?�l ZSZ- /$t�/ <br />TENANT <br />MAIL ADDRESS CITY ZIP PHONE <br />ARCHRECTORDESIGNER MAILADDRE55 <br />��7y ZIP PMONE <br />GENERALCONTPACTOR MAILA�DPE55 CITY ZIP PHONE STATELILENSEI <br />PLUMBING <br />MAIL ADDRE55 <br />CONTRPCT PRICE OF WORK <br />�Z,S-a—' <br />DESCRIBE WONK AND S�IIARE FOOTAGE INVOLVED <br />PflOPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTV (SMOWN OELOW Ofl ATTFCH TWO COPIES) <br />LOT BIOCK OF <br />PARCELTAX�.D.NUMBER <br />CONSTflUCTIONLOANlENOER, <br />TYPE <br />WATER CLOS <br />CITV ZIP <br />-��r�8 6lVe <br />CIN ZIP <br />i5. TELEPHONE NUMBEP <br />31. �,syq-. <br />NRE OR ITERI PEE <br /><ITCHEN SINK 8 DI5F <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FUUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—RA�� <br />FOR OFFICE USE ONLY: <br />�.....��ecmec¢ PEARSETBACN <br />IISE <br />TVPE OF CONST <br />flEASON <br />LOT AREA <br />FIRE SPRINNLERS HEO'D <br />DATE <br />BY <br />iTAL $ <br />a <br />FEE $ <br />SI7E SETBACK <br />PHONE <br />PHONE <br />CONTRCT PERSON AND PHONE NO. <br />STATE LICENSE II <br />� 'f9IW/Y09 �ib �- <br />STATE LICENSE � <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 TH!" TYFE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECiFIED HEREIN OR <br />N�JT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 1�HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OIl THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORIA THE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />��..,�� ^ (y - Z2-�13 <br />SqNAipRE �RE <br />TYPE OF EOUIFMen i <br />q/C—NHNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATEHS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />HEAT PUMP <br />GAS PIPING <br />FXHAUSTFAN <br />SUB TOTAL $ y/) ' - <br />PERMIT S ' <br />TOTALFEE $ ' <br />FEE I RECEIPTNO. <br />V�CANT SITE i <br />❑ YES � ND BUILOING <br />i <br />acuv.xc. xoorowewxeuxns � <br />�A�P PLUMBING � <br />BASEM�NT � <br />MECHANICAL <br />❑ YES ❑ NO ' <br />HEIGHT IIMITATION ADDITIONAL PLAN CHECK ' <br />� <br />OTHER ' <br />i <br />STA7E BUILDING SURCHAfiGE ' <br />CITY OF EYERETT PUBLIC WOHKS ' <br />LOCAL SALES � <br />TAX CODE IS 3105 TOTAL � <br />