Laserfiche WebLink
APPLICATIC I FOR CONSTRUCT ZN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT cvr�%rr <br />BUILDING DEPARTMENT I "amiFlUOTOICAS: JLiAS <br />(A ELECTRIC <br />259-8810 <br />( I DEMOLITION <br />CI COMBINATION X <br />BUILDING <br />I I MECHANICAL <br />] PLUMBING SIGN <br />OWNER <br />AUIL ADDRESS <br />L Y <br />ZIP <br />PHONE-- <br />----- <br />iilG <br />TENANT <br />Cyp��/t <br />V203 <br />Jr,;-'ID.??7 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />_ &41" ti <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />-SamZ <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />ME,CH1ANIC��AA{LCONTRACTOR <br />JV /R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />PLUM ONTRACTOR <br />[[9L�INO CH1 r <br />MAM1 ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE E <br />COI TRACT PRICE. OF WORK <br />�A <br />EBCI IBE WOR ( A /D}SGGUUJARREeFOO AGE 1 OL ED <br />C T(ICT NSON A P ENO j <br />I <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />5E9aGL <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />V/ Af <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGALDESCRI NOF <br />OPERTYISH OELOWORATTACH TWO/COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT—.� BLOCKOWD-o/ OF L'�%Q Qt J.�i" 9 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />y <br />AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />t P7iy ✓C11. <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />,L ,/� <br />VI PLJ 7Yac-/� /pLQQ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAX I D NUMB6 <br />S' ^ O <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />O <br />CONS7ATHILILOAN LENDER. ADDRESS. iE'.EPHONE NUMBER <br />// <br />PROJEC ADDRESS <br />�j��//� <br />� <br />--'^^ �✓� v // 4�C{� <br />CITY BL9Ncm fcrSFw <br />_ PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-ATHNDLG UNITS-H.P. <br />PATNTUB <br />FORCED AIR SYSTEMS-B.T.U. tiI E.A <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />�- <br />SHOWER <br />CLOTHES DRYERS <br />�- <br />_ <br />KITCHEN SINK 8 DISP <br />' <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />, <br />WATER HEATER <br />r <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT <br />HEAT PUMP <br />; <br />, <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />I <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />SINK (SERVICE -BAR, ETC.) <br />, <br />, <br />i <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ _ <br />PERMIT $ <br />TOTAL FEE $ <br />_ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR', <br />, <br />USE ZONE <br />LOT AR <br />TYPE OF CONST <br />NO OF <br />(J <br />SIZE OF BLDG <br />FIRE SPI <br />_ N//� <br />HEASON <br />INTAKE BY <br />DATE <br />BACK <br />SIDE SETBACM� <br />PLAN CHECK NUMBER <br />EFI <br />VACANT SITE <br />C YES ❑ NO <br />FEES <br />BUILDING <br />— <br />DRIES <br />OCYUTENLY <br />0-31 EENp <br />K aoMtuly.wns <br />I <br />PLUMBING <br />IKIEHSREDD <br />BASEMENT <br />D YES (p'N0 <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />E REf, <br />O <br />NEgHrt MOATq� <br />OTHER <br />STATE BIIILDING SURCHARGE <br />VEOBY <br />ld <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX COOS IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />RECEIPT NO <br />a <br />