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IXTION FOR CONSTRUCTION <br />TO BE CO"r_ETED IN BLACK INK —PLEASE PRIN~ <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />HEATING SYSTEM: GAS 0 ELECTRIC 0 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING] MECHANICAL ❑ PLUMBING ❑ SIGN <br />OV"a , MAE ADORESI v <br />COPRACT PA <br />DE11CRIN WOW AND NOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />c 'r <br />ac <br />�A.Dwo <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 18.2277 R/CCW9 AND�j29,6,2200 WWAC. C}" <br />snN. LVIL L <br />P <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK OF <br />PARCELTIUII.O.NUMBER <br />CpMTRUCTIONLOAN UNDER. ADDRESS, TEUPIIONE NUMBER <br />PRQIEQ ADDR888 lf v �l v 1 <br />\ C1 '� <br />I.r PNtiNf 99,tfN5l 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 />AJC—A,HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U.. M E.A. <br />LAVATORY WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER 1, <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRYTRAY <br />WATER HEATER <br />, <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT ' `) <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK SERVICE —BAR. ETC.) <br />, <br />, <br />, <br />SUB TOTAL S <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE E <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHEC NUMBER <br />FEE <br />RECEIPT NO. <br />J� Q� <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />^.. YES NO <br />BUILDING <br />, <br />TYRpCpRT. <br />NO OF STORIES <br />acuNAcr <br />NO aO'Al0✓.u9119 <br />PLUMBING <br />, <br />EA" <br />BITE OF BLOC. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />MECHANICAL <br />0 YES Cl NO <br />OCCUPANCY L:AU <br />FIRE ALARM REO'D <br />HEIOMT LIMITATION <br />ADDITIONAL PLAN CHECK <br />' <br />, <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE sr <br />PLANS APPROVED BY <br />CITY OF EVEP.ETT <br />PUBLIC WORKS <br />) <br />LOCAL SALES <br />TOTAL <br />DATE <br />TAX CODE IS 3105 <br />o] <br />