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APPLICATICai FOR CONSTRUCT��7N PERMlT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT L HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION L COMBINATION ❑ BUILDING `�MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEP MAILADDRESS CITY 21P PHONE <br />1- i� H-�r� Ci'r�c���-,ra ia0 5�.��,��,�+� �rnli i�ln,� fa���l� lA/!1 �'l�'.-x��C ��%�' '(57�L/- <br />TENANT <br />ZIP PHONE <br />ARCHITECTpRDE51GNER MAILPODRE55 LITV ZIP pHONE <br />GENERALCONTPACTOR MAILADDRE55 <br />CI7V <br />PHONE STATELICENSEa <br />MECNFNICALCONTPACTOR MAILADDRESS CIN 21P PHONE STATELICENSEx <br />�a�;eu�_CoTnc• Iao,� Ch�s�u�� 8 EVE2�Ef 9d��) �,53- +J� SE1�vic�o5aa3 <br />PLUMBMCCONTFACTOR MAILADDRESS QTY ZIP PHONE STATELICENSEp <br />CONTR� P�,/ � 8 b � <br />�ESCRIBE WORK AND SOIIRRE FOOTAGE INVOLVED <br />A/C GtnrJ ho�-i'ti� <br />PROPOSEU VSE OF BUILDING <br />LEGAL �ESCRIPTION OF PqOPERTV (SHOWN 9ELOW Ofl ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTA%LD.NUMBEfl <br />CONSTRUCTION LOAN LEN�ER, ADDRESS, TELEPHONE NUMBEP <br />PROJECTADDRESS <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET(TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WPSHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />USE T.ONE <br />ttPEOFCONST. <br />SIZE OF �LDG. <br />OCCUPANCYLOAD <br />PEASON <br />INTAKE BV <br />FIRE SPRINKLERS REO'D <br />FIRE ALARM REO'D <br />PLANSAPPFOVEDBV <br />DATE <br />SI�E SEIBALK <br />VACANT SITE <br />❑ YES ❑ NO <br />acuaaxcr rm.ormv[wxcuwrs <br />taouv <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF EVEHETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACT PEfl50N FND PHONE NO. <br />I HEREBY CERTIFY T4AT I HAVE READ AND EXAMINED iHiS <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 WHICIi <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C0�lTRACTORS LAW 1827 RCW AND 296200 WAC. <br />� G'F�'l,� Z,Z,�— r� � <br />9GNAIDPE DATE <br />C?TBUSMESSLICENSENO. <br />TVPE OF EQUIPMENT FEE <br />AIC—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIflEPLACE ( <br />FIRCPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT $ <br />FEE I RECEIPTNO. <br />� <br />BUILDING i <br />PLUMBING � <br />i <br />i <br />MECHANICAL • � <br />AD�ITIONAL PLAN CHECK ' <br />i <br />i <br />OTHER � <br />STATE BU�LOING SUFCHAqGE i <br />i — <br />PUBLIr, WORKS ' <br />i <br />TOTAL i <br />