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� <br /> APPLICATIC-'1 FOR CONSTRUCT )N P`ERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS U ELECTRIC lJ <br /> 259-8810 <br /> I I DEMOLITION I ' C05ABINATION � ! BUILDING I i MECHANICAL I I PLUMBING ' i SIGN <br /> OWNER MA�LADDRE55 � - ��� ��� p � ��_��I� <br /> M 1►�C Cr)l[- �21h l0 '" ST, 5,�. <br /> TENMII MAII�D�RE55 CITV ZIP PNONE <br /> �RCNITECTOIIDESIGNER II�IL�UORESS CITV IIP pNONE <br /> 6ENERQCONTR�CTON M�IL�DORE55 CITY LIP PHONE 5TIITELICENSEI <br /> MECH�NICl0.CONTR�CTOII M�IL�DDRESS CIiV 21P PHONE ST�TE LILENSE� <br /> �wru�w srn��=s�:�n�ni 3y i� ���-s cv�,u�r y8�� as�-3��y L-ti��t455�2/k � <br /> PLUMBINO CONTR�CTOB MAL��DRE55 CITV ZIP PHpryE STATE lIC SE� <br /> CONfMGT PflICE OF WORI( i3�o Q � <br /> y FoU.00 <br /> DE9CRIBEWqIK�ND6dl�REF00TAQEINVOLVEO �ISDU 5(�I / � CONT�CTPERSbN�N0V110NEN0 <br /> 1US/ri1( �5 �'t,�rLNI�CL t u`4Jo21^� <br /> I HEREBY CEFTIFY THAT I HAVE RFAD AVD E%AMINED THIS <br /> PROPOSEDUSEOFBUkUINU APPLICATION AND KNOW THE SAME TO 8[TR,IE AND CORRECT.ALL <br /> R�t�cPc+�n+�l � Sl �C � PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br /> lEGA1.DESCRIPTpNOFPf10PERiYISNOWNBELOWOR�R�CHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> NOT. THF GRANTIMG OF A PEFMIT DOES NOT PRESUME TO GI\'E <br /> �ot e�ocK ov AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> . OTHER STATE 0(i LOCAL LAW pEOULATIN6 CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WOHK FOq WHICH <br /> AP�LICATION IS MADE AND I COMPLY WITH THE STATE <br /> ' PARCEL TA%ID.NUMBER CONTRACTORS LAW 18. RCW AND 296.200 WAC. <br /> CONSTRIILTION LOAN IENDER.ADDRE53.TEIEPNONE NUMBER <br /> � y��b�y3 <br /> PR �� ODR SB � saHnunr - o��c .. <br /> CI1Y11114N1E59Uf.fNSf NO <br /> PLUMSINO MECHANICAL <br /> NO. TYPE OF flXTURE OA REM FEE NO. TYPE OF EOUIPMF.NT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDIG UNITS—H.P. , <br /> BATHTUB ' � FORCED AIR SVSTEMS—B.T.U. M EA. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHESDRVERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER W000 STOVE ; <br /> URINAL METAI.FIREPLnGE(WOOD BURNINO) � <br /> ORINKIN6 FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPIN6 ' <br /> ROOF DRA�NS—RAINLEADERS � EXHAUST FAN � <br /> SINH(SERVICE—BAR,ETCJ � <br /> � ; <br /> _ � <br /> T <br /> SUB TOTAL S ; SUB TOTAL E ' <br /> PERMIT E PERMIT S 7 � <br /> TOTAL FEE S TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRGNTSETBACK REARSETBACN SIOESETBACN PUNCHECNNU49ER FEE NECEIPTNO <br /> USE ZONE LOi�RE� VAC�NT SITE FEES VALUATION FEE <br /> ❑ V[S f� NO BuaDiNO <br /> trr[acoxsr raoPstoqies «cu.u<. woaowFumcw��s — <br /> c�o pLUMBi�ni <br /> 6RE Of B106 FIRE SPPINNLERS REO'0 BASEMENT MECHANICAL � <br /> Cl YES f-1 NO , <br /> OCGUPANCYLWD FIREAIARMNEtrO HEH1NTlIMIT�710N ADDITIONAIPUNCHECK i <br /> i <br /> OTHER � <br /> _ � <br /> nF�Sd1 <br /> STATE BUILOMG SUHCHARGE ; <br /> INT�KE BY PUNS�PPROVEO BY CITY OF EYERETT PUBLIC WORKS ' <br /> LOCAL SALES � <br /> o�re TAX CODEIS 3105 TOTAL � <br />