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APPLICATICJ i FOR CONSTRUCT`�-1N pERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM fJ GAS �ELECTRIC ❑ _ <br />BUILDIN3 DEPARTMENT — <br />259-8810 gUILDING L I MECHANICAL I. i PLUMBING <br />! 7 CEMOLITION I I COMBINAI'ION k Z�P PHONE <br />�,ina nooaess cirv <br />OYlNER C� � — � <br />�h �' ( PHONE <br />f GTY ZIP <br />TEN� IAF�L ApDRESS <br />AqG��� Tp DESIGt.�P IAAILADORE55 <br />GEIlER�L���P[� '� <br />lSf ��!T""'�V�l l i� 1(� 1 ��- <br />M1IECHANICALCONTRACTOR MNLAD�Rtaa <br />PLUM �N� NiPACTOfl MFIL ADDRE55 <br />Tr�harY1�+�"'�� rta <br />G01�TRACT PRICE OF WOFH <br />� �,--1 nnc� . c�b <br />�ESCRIBE WOP ( AND SOU�flE FOOTAGE INVOLVED <br />:�noaoseo use oF <br />�H <br />t�t�r—. --�='�� <br />LEGFL DESCRIPTION OF PROPERTV (SH WN DELOW OR ATiFCM TY40 ��P�ES� <br />�{ �� �yq���' �� �fJ <br />�nT—{g__ BLOCK OF �-�--� <br />v <br />rnx i.o. �+i <br />4�1—.-.- �' CICYZCS-1 � - <br />UCTIONLOANLENDER.AD�FESS.TELEPHONE� <br />=r� �. Y��q� '�C�CICI� <br />ECT ADDRESS ' �[:O1 �' ��'" <br />n �� .� ��� <br />JMBING <br />TYPE O"r FIXTUflE OR ITEI <br />WATER CLOSET (TOILET) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWA5HER <br />LAUNDflYTRAY <br />CLOTIi[S WASHER <br />URINAL <br />DFINKiNG FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE—BAR. ETC.) <br />CITY <br />CITV <br />CIiV <br />.• <br />L', SIGN <br />ZIP '' "^` <br />Z�p PHONE STATELICENSE+ <br />�'� ' l e9£�� 4B3 S�(�(� k <br />21��1NE STATEU EN Ee. <br />Z�P PHONE STATEUGENSEP <br />� �fl�4-S 4 AR -�F�15 fk Fl,� �n � � a � � <br />�o <br />_ o��Q � <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 WHE?HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERNiIT DOE3 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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEC BY THE <br />OWWER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIOfd IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�t'C/ko�-�i.l ��iu...-L. .�li �v %3 <br />o E <br />' $iGR4IDRE <br />> <br />.—o„��Ncssucirvservo _� <br />FEE NO. TYPE OF EOUIPMENi <br />AIC—A,�HNDLG UNITS—H.P. �—;— <br />�— FORCED AIF SYSTE�hS—B.T.U. M E.A. <br />; UNITHEATERS—B.T.U. M __� <br />� <br />� CLOTHESDRYERS — <br />� VENTILATION FAN ----r— <br />� , <br />— RANGEHOOD � <br />� � WATER HEATER — <br />WOODSTOVE � <br />� MEIAL FIR OOD BURNING) ' — <br />�� FIREPLACE!NSERT <br />HEAT �UMP , <br />- � GAS PIPING � <br />— . FxNniISTFAN �-- <br />- 1 <br />SURTOTAL 5 �_.T <br />PERMIT 5 <br />TOTALFEE 5 __ <br />FOR OFFICE USE ON�Y: <br />iRCNTSETBACK REAHSETBACN <br />�� ( ��� � __ <br />USE 20NE LOT APEA <br />. I �� �co <br />iVPE OF CONSi. NOAF STORIES <br />1 <br />52E OF BLOG. FIFE SPRINNLERS REO'D <br />�" 5 AD �— <br />� � fIREAIARIdREO�D <br />OGCIIPANCYLOAD <br />INT�KEBY VL��JSAPPR��E�OY <br />S �. <br />oATE-,�ti�la� <br />SIDEiETBACN PIANGHtcnn�rnom <br />� � y�i � � <br />VACANT SITE FEES <br />] YES � N� gui�Dir�G <br />GCCOP0.':p i�0 0%OfIFV:VLUSlS <br />0-�3 PLUAIBING <br />BASEMENT h�ECHANICAL <br />r �, ves T�tio <br />- ADDITIONAL PLAN CHECK <br />HEiGHT LI6VT�TION <br />U � OTHER <br />�>' _ <br />STATE gWLDWG SURCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rurn� <br />SUBTOTAL J <br />PERMIT 5 <br />Tnrai FEE 5 � <br />FEE �/ REGE(J/�TNO <br />/�0. /i�— O /��.� /1 <br />