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APPLICATIQ'`l FOR CONSTRUCT'7N PERMIT � <br />TO BE COMPLETED IN BLACh: INK—PIEASE PRINT <br />� HEATING SYSTEM U GAS Id ELECTRIC i,J --1 <br />BUILDING DEPARTMENT ' <br />259•8810 <br />nFu�ni iTinN COMBINATION � � <br />OR <br />BUILDING MECHANICAL PLUMBING SIGN <br />M �DI -55 �'��' � CiTY ZiP PIqNE <br />5or� ����yldrN- cBn36 ��'�69Ao <br />MAIL�JDRE55 % LITV Zm PHONe <br />ER � M�ILADDRE55 CITV ZIP PHONE <br />IA411 <br />CLASS OF WORN <br />/NEW ADDITION <br />ALTERATION <br />CONTR�Li PAICE OF WORK <br />DESCRIBE WORK �N� SOUARE fOOTAGE INVOLVE� <br />Pf10POSED USE OF BUI�OIN7 <br />LE WL DESCRIPTION OF PHOPERTY �SHOWN 6EL01 <br />lOT _ BLOCN OF <br />0 <br />���;� � � <br />� PLU�dBINO <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASINI <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—PAIN <br />FOR OFFICE USE ONLY: <br />f��)tJiSEi��Ck REARSETBACK <br />�?! 2 � <br />��5� z� 3 <br />� <br />irr[ ar cor�rs nuowneic <br />2�Sf <br />SF d <br />OCCUPRNCYIOAD <br />�-f��— <br />n[ qSON FOq SPRII <br />INiANE BY <br />�%� (Z. Z <br />rvr[ ar coxst ecnui <br />�—� <br />NO Of STOP:ES <br />2 <br />GIRE SPBNRLERS REO'D <br />s <br />CRV ZIP <br />GIiY IIP <br />REPAIR DEMOLITION <br />S` S� �L <br />SIDE SETBACK <br />5 <br />V�CRNT SIiE <br />PNONE <br />� <br />P110NE <br />PIqNE <br />Si�TE LICENSE � <br />� <br />STATE LICENSE � <br />WOODSTOVE/FFPL INSERT BUILDING RELOCATION <br />GONTRCT PF.RSON �N� PNONE NO <br />i HEHEBY 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 GOVEhNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEPEIN OR <br />NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE O CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF TH PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPL�CATIO IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT 5 LAW 1827 qCW AND 296.200 WAC. <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RA�lGE HOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSEflT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />�� . <br />�IECB NUMBER <br />� ��C C^_/l' <br />BUILOING <br />«.mwrc. xoaow�uwnur��s <br />"°"°3 2 PLUMOING <br />B45EMENT MECMANICAL <br />N� <br />dEIONT IIMITRION AODITIONAL PLAN CHECK <br />SPRINNLER <br />STATE BUILDWG SURCHARGE <br />CITY OF EYERETT PUBLIG WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 Ta*p� <br />/��7 : ci ) <br />sue rorn� a �— <br />PERMIT S <br />TOTAL FEE E <br />RECEIPT NO <br />.3� <br />VALUATION FEE <br />/09970 l� � �c <br />i <br />.-7 % r� i c'� <br />i <br />�U � Oc> <br />.:� <br />� <br />