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APPLICATIC^l FOR CONSTRUCT'-lN PERNIIT � <br />' TC BE COMPLETED IN OLACK INK—PLEASE PRINT <br /> BUILDWG Dc,PAF�i MENT HEATWG SYSTEM: ❑GAS iL�l ELECTRIC ❑_ � <br /> 259-8810 <br /> ❑ DEMOi_ITI�DN Li COMBINATION Cl BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILAD�RE55 CIiV 21P PHCNE <br /> �.��1' ¢�oCG. a9olo -�n. Avt. ,� Eva�eErr 9r'aa 5� .�s=t�9fo <br /> TENAnIT MAILADDRE55 CITY ZIP PHONE <br />` ARLMITECT OR DESIGqEH MAIL ADDRESS CITY ZIP PHONE <br /> GE�IEPA�WNTRACTOR MA�LADDHESS ryT'I ZIP FHONE STATELICENSEt <br /> MECHANICALCONTPACTO9 MAII.ADDRESS CITV' ZIP PNONE STATELICENSEa <br /> .r�_tn� t�✓�6v i979/-�Y�+/-�vE.c�,' � NNs✓O�t,p 43e3G 9�y-83�� Ti� -z�� ESoL �TN <br /> PLUMBIYG CONTRACTOR IAAIL ADDFESS CITY ZIP PHONE STATE LICENSE N <br /> CONTRACT PBICE OP WORN ,�= �i <br /> 3oc� v <br /> DESCRIBE WORK AN�SOUAfiE FOOTA�E INVOLVED CO�lTAGT PEflSON PND 7HONE NO. <br /> s/E<+r .ov.,�r o . .+Ele[.0 7'J�/-c'���s— <br /> � � 1 HEREBY CSRTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PRGPOSED 115E OF Bll!I i ING ApPLICATION AND KNOW THE SAME TO BE TRUE AND CORiiECT.ALL <br /> PROVIS�ONS UF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY'SHOWNEELOWOFATTACMTWOWPIES� WORK WILL 6E COMPLETED WITH WHETIIER SPECIFIED HEREIN OR <br /> NOT. THF GRANTING Or A PERMIT DOES NO? PRESUME TO GIVE <br /> , �or- - eiocK— �F - AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW 9EGULATIIJG CONSTRUCTION OR THE <br /> . -----� PERFORMANCE OF CO�VS"fRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF Tf115 PRO?EriTY TO PERFORM THE WORK FOR WHICH <br /> -- - APPLICATION IS MA[lE AND I COMPLY WITH THE STATE <br /> PApCELTA%I.O.NUMBER CONTRACTORS LAW 78 2%HCW AND 296200 WAC. <br /> �3a8ny -a -o� - o00 <br /> CONSTRUCTION LOAN LENOER,ADDRESS.TELLPHONE NUMBER <br /> , —_ x � ,d;C�.c�e:�,.L- 6�s�y`f <br /> � /'ROJECT ADOflESS s��cr 5*unE l�a .)�y,� o"TE <br /> . �' , W , cirvousinEssucENSErvo . <br /> • PLUMBING MECHANICAL _ � � ' . <br /> NO. TYPE OF FIXTUfiE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE , - <br /> � WATERCLOSET(TOILET) � .4IC-A/HNDLGUNITS-H.P. � , � � -�"������� <br /> � BATHTUB FORCED AIP.SYSTEMS-B.T.U. M E.A. ' �. ` <br /> � LAVATURY(WASH BhSIN) UNIT HEATEFS-B.T.U. M � � <br /> - SHGWER ' CLOTHES DRYERS ' <br /> ' KIICHEN SINK&D!SP ; VENTILATIUN FAN I <br /> � DISHWASHER � RANGE HOOD ' <br /> � � LAUNDRY TRAY ; WATER HEATEfl ` <br /> _ � <br /> � JLOTHES WASHER � WOOD STOb'E <br /> U"ri!bIAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE II�SERT � <br /> FLOOR DRAIN � / HEAT PUMP ' <br /> Bi�CKFLOW PREVENTERS i GAS PIPING � <br /> . -- � <br /> ROOF DRAINS-RAINLEADERS EXHAU�T FAN _ <br /> ' SIIJK(SERVICE-BAR,ETC.) ; � <br /> — - - � � <br /> — --- - , � <br /> — -.. - � — � <br /> � <br /> -- - , � <br /> SUB TOTAL $ ; SUB TOTAL S D ; <br /> PERMIT $ � PERMIT 5 <br /> TOTAL FEE 5 ; TOTAL FEE S � ,y <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETPACK SIDE SFTBACK PLAN CMECK N MBER FEE RECEIPT NO. <br /> 0 <br /> USEZONE LOTAREA \'ACANTSITE EES VALUATION FEE <br /> ',-_.'� YES ❑ NO BUiL01NG ' <br /> NPEOFCO�lST NO.OFSTORIES rctucpxc+ no.orvx[wxeusits — � <br /> caouv pLUMBING � <br /> SIZE OF BIDG. FIRE SPRINNLEFS REO'D BASEMENT � � <br /> MECHANICAL ' <br /> ❑ YES ❑ NO <br /> OCCUPANCY�OAD FIREALARMREO'D HEIGHTIIlAITATION ADDITIONALPLANCHECK � <br /> i <br /> OTHER i <br /> — T <br /> REASON i <br /> STATE BUILDING SURCHARGE ' <br /> INTpNE BY PLANS APPROVED Pl' CITY OF EUERETT PUPUC WORKS i <br /> LOCAL SALES r—" <br /> DATE TAX CODE IS 3105 TOTAL <br />