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Hzq m <br />En <br />APPLICATIO. _ FOR CONSTRUCTI _,N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />'SEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ 7 <br />BUILDING DEPARTMEN i <br />259-8810 <br />DEMOLITION COMBINATION LI BUILDING I MECHANICAL I- I PLUMBING SIGN <br />MAIL ADDRESS <br />/V 2- .5.`• /' <br />fA// <br />TENANT <br />AIL ADDRESS <br />CITY <br />21 <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICLNSE8 <br />❑ NEW ❑ <br />a <br />F I AITCDATInNI y RFPAIR I I nFMOI-ITION I WOODSTOVE/FRPL INSERT 13 BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />('� <br />Z O <br />CONTRACT PRICE OF WORK 7 0 , <br />DESCRIBE WORK AND SQUARE FOOTAGE NfOLVED <br />s, /C r <br />PRO SED USE FBUILOING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />s raY Y'i <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS COMPAND LETED WITH WHET GOVERNING THIS REIN OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN( BELOW OR ATi HFOU� RCO ES) <br />6 �AT7 <br />LOT `..L— BLOC of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITW 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 />• <br />OWNER OFTHISPROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 R"(CWW AND 296..2000WAACC._ <br />X <br />SD RE OATE _ <br />PROJECT ADDRESS <br />OZ IS ; /4 / <br />CITY BUSINESS LICENSE NO <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—A/HNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />i <br />DISHWASHER <br />' <br />RANGEHOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE B CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP — <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />i <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />_. <br />r <br />I <br />' <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />Y•rinC InG n\II V. <br />FRONT SETBACK <br />REAR SETBACK <br />S;6E SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />21& 1 �� <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />DCWPM6r <br />■ 0FDYrtllJNBUNITS <br />cnaP <br />PLUMBING <br />i <br />SIZE OF BLOC. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />I <br />i <br />OCCUPANCY LOAD FIRE SPRINKLERS REDD HEIGHT LIMITATION <br />I <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />L i <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVEflETT <br />PUBLIC WORKS <br />1 <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />2 L <br />