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C <br />APPLICATIOA ;OR CONSTRUCTII .4 PERMIT <br />TO OE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER � MAIL ADDRESS LITY ZIP P)Ht <br />%%A�iE o��.eJ �z z FK <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />Sif'/Z%%� <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />OEN AL CONT OR MAIL ADDRESS �- CITY ZIP PHONE BTATE LIOjfIN�E�/p7� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />CLASS OF WORK <br />i I NEW �[ ADDITION ALTERATION REPAIR DEMOLITION I WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />B/ <br />CONTRACT PRICE OF WORK P <br />CONTAC ER AND NONE NO. <br />di7 V <br />DE RIBE WORK AND SOUAR TAGE INVOLVED <br />PROPOSED USE OF BUILDING <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 WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. 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 18.27.`RCW AND 296,200 WAC. <br />X <br />LEGAL DESCRIP ON OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />— _ <br />Lor BLOCK OF �Q(�Ii( <br />PROJECT ADDRESS ��-\/'� \/�C <br />� / �/ l/ <br />RKiH"T1/NE `OVEs/9L <br />clry BU5ME591(CEN4E NO V <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C-NHNDLG UNITS-H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />i <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR, ETC.) <br />' <br />s « <br />S' ' ^ <br />, <br />1 <br />SUB TOTAL $ <br />,S� �— <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />' <br />sma [1FFICF I IAF ANI v. <br />FRONT SETBACK <br />REAR SETBACK <br />BIDE SETBACK <br />PLAN CHECKpy <br />O✓ <br />fFE �rJ <br />RC�;+O <br />A/l <br />USE ZOTIE <br />^ <br />LOTAREA 2 <br />/ ✓� <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Z O <br />�A.A ' do <br />i <br />ido <br />TYPE OF CONTS AL LOWABLE <br />TYPE OF CONST ACTUAL <br />-1 <br />OIX(NLNCY <br />ONdN� <br />NO OFMILINY044 <br />SIZE OF BLDG <br />NO OF STORIES <br />EASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRINKLERS REO'D HEIGHTU ITATION <br />N/A ffi- <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />' <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />IJ H <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />f <br />' <br />TOTAL <br />so <br />