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APPLICATIC'1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPAR7MENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />CJ DEMOLITION ❑ COM8INATION �i BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILAO�RESS CITY ZIP PHONE ZS2 "'S�/d/ <br />�� �_ � _ ' _ w� <br />GENERAL <br />LIAIL ADDRESS <br />// . l_ <br />ct� <br />/MILADDRESS <br />MAIL ADDRE55 <br />T PRICE OF WOqK <br />Z7,.S%o .Ot� <br />DESCRIBE WO(U( ANp SqUpE FOOT�GE INVOWED <br />�3�.��- <br />use r� <br />lEWL0E8CRIPfqNOFpqppEqry�g{pWNBELOW ACX <br />�oT�_ �� G �� � R; <br />��(�Lr'�.�'�'r �/ (�/.�N/13 <br />PAqCELTN(I.D.NUGIBEP <br />T�L37/-�i73-Oo� <br />cONeTM1CTI0N LQW LENDER, ADDfiES3, TEI :PHONE NUMBER <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KRCHEN SINK 8 DISP <br />DISHWASHER <br />UUNURY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />TOTAL $ <br />FOR OFFlCE USE ONLY: <br />� FRONTSETBACK REARSETBALK <br />I <br />I USEZONE LOTAREA <br />� lYff Of CONST. NO.OF STOFIES <br />SREOFBLDG. FIRESPpINKLERSXE�'D <br />� ^�O 5� <br />P <br />. OCCUPANCVLOAD FlREALARMflEO'D <br />� <br />� <br />RE�AON <br />' IM111(E BY <br />PUNS APPROVEO_ ^BV <br />J���" <br />�ATE y�"S/n <br />Z�is <br />y <br />cin <br />�fG, <br />�G �r� �is�4 <br />ZIP PNONE <br />Ziij_ PHONE�" S�ENSEI <br />y;° /�'1/}2fs�•«� �,,J� �-70 <br />ZIP PMONE / G.)�ONB�^ <br />( V <br />ZIP PHONE STATE IICENSE i <br />NlTAC ��SONC AN��NO�/� /%,%id/LF . <br />�/Gs�Gt�"�-✓LLdtD o!�Zf�I�E Z.�Z-S/rH <br />I HEREBY CERTIFV THAT I HAVE HEAD AND EXAMINED THIS• <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �� <br />OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OR THE , <br />PERFORMANCE OF CONSTRUCTIUN. THAT I AM A�f+19R1�EB�BY THE <br />OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827pCW AND 298200 WAC. _ <br />rrne oF <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEHS <br />VENTIUITION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPUICE (WOOD <br />FIREPLACE INSERT <br />HEATPUMP <br />SIDE SETBACN PLAN CME� K NUMBE FEE <br />v�capr site FEES <br />❑ YES ❑ NO BUILDING <br />OCp1MMCY MO OfpW[LLIMGIlN115 <br />�"a" PLUMBING <br />B�SEMEM MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LUAITATrot�l ADDITIONAI PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCAL SALES <br />z TAX CODE IS 3105 �TAL <br />M E.A. <br />SUB TOTAL $ <br />PERMIT $ <br />� <br />� <br />