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APPLICATIC�I FOR CONSTRUCT )N PERMIT � <br />YO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: f- GAS C} ELECTRIC ❑_ � <br />259•8810 �� <br />❑ DEMOLITION ❑ CAMBINATION ❑ BUILDING L�i MECHANICAL C] PLUMBING ❑ SIGN <br />OWNER M�ILADURE55 CITv ZIP PMONE <br />Pa2ciP�A�u..aN /A��� // .)i, �.F,�:-i 9420/ S2z-77.`>S� <br />TENANT MAILAOORESS GTV ZIP PHONE <br />AflCHI1ECTORDE5IGNER MAILADDN:l5 C17V ZiP PMONE <br />GEr1ERRLCONTRACTOR IANIADDRESS CITY ZIP PNONE SiAIELICENSEu <br />MECM4NICALCONTRFCiOR <br />I/_.. _, !I— <br />PLUMBING <br />MAIL ADDFESS <br />�JITRACT Pfl'�IG1E OF WOflK <br />..i�/ �O UC/ � <br />DESCRIBE WORK AND SOUAPE FOOTFGE INVOLVED <br />CITV 21P <br />=R�'T% %` "8�0?� ,?S. <br />QTV ZIP <br />GONTACTPERSONANDPHONENO. <br />PROPOSED USE OF BjjlLqfyGIG� <br />S/� <br />LEGAI. DESCRIPTION OF PiiOPERTV (SHOWN BELOW OR ATTACH TWO COPIES� <br />LOT BLOCK OF <br />PARCELTAXI.O.NUldBER <br />CONSTRUCTION LOAN LENOER, <br />PLUMBING <br />O. TYPEOFFIXTUREOR'�EM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING fOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEflS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FEE <br />S�.JB TOTAL $ <br />PEFMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSET9FCK REARSETBACK <br />USE 20NE <br />NPE Of CONSi. <br />SREOFBLUG. <br />OCGUPAACVLOA7 <br />REASON <br />INTAKE BY <br />LOT ARE� <br />FIRE SPRINKI.ERS REO'D <br />FIRE ALAflM REO'D <br />PLANS APPROVED BV <br />DATE <br />SIOE SETBACK <br />PHONE <br />^ <br />PHONE <br />STATE LICENSE a <br />9LLEA�/ <br />STATE UCENSE k <br />I HEREBY CcRTIFI� THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KPJOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GO�'ERNING THIS TYPE OF <br />WOFK WILL BE CUMPLETED WITH WHETHER SPECIFIED HEREIN Ofl <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEF STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEAFORMANCE OF CONSTFUCTION. 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 />CONTRACTORS LAW 1827 RCW AND 296.200 W.4C. <br />x ��� �r7rt�n�l .�-/.S-l�i` <br />SicN runE oatE <br />Cliv pu5ME5S IICENSE NO <br />MECHANICAL <br />NO. TVPE OF EQU!PMENT FEE <br />FVC—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTeMS—B.T.U. E.A. <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS <br />VENTILATION FAN <br />FANGE hi00D � <br />WATER HFATER <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />! GAS PIPING ; <br />VACANT SITF. FEES <br />G YES ❑ NO BUILDING <br />LCCOP4NCV N� OfOW[iUNGUNIiS <br />cnouv PLIJMBI^1G <br />BnSErnENT MECHANICAL <br />❑ YES ❑ NO <br />NEIGHTLIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATFBWLGWG SURCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LUCAL SALES <br />TAX CODE IS 3105 TO7AL <br />SUB TOTAL 5 � i <br />PERMIT 5 � / �� <br />Tnrei FFF a Cc!'� � <br />FEE � PECEIPT NO. <br />N <br />� <br />