Laserfiche WebLink
APPLICATIQ�I FOR CONSTRU�T'"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM� ❑ GAS O ELECTRIC �7 _ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION [� COMBINATION ❑ BUILDING ❑ MECHANICAL oNE ❑ PLUMBING ❑ SIG <br />OWNER MAILl1DOF1ESS S(�i�� � ��ry ZIP <br />t ic�' S�i' d'-4oa <br />8lC+-P�.o ii�� S��v Gu� SF E��S-rr N'�qGGGL+q�r EV �1�7 9cF �PHONE <br />TENANT <br />MAILADORESS ��TM Z�P <br />� ��n, Z�p PHONE <br />ARCHITECTORDESIGNER MAILAODRESS <br />/tiii�LF�' NE STATEL4'ENSEM <br />�TRACTOR MAIL <br />5 �'�- <br />ADDRESS <br />CONTRFCT PRICE OF WORK <br />DESCRIBE WORK I.NO SOUARE <br />� <br />PROPOSED USE OF BUILDING <br />�N6A'/'�wr Pf'wr�/�L — <br />LEC�AL DESCPoPTION OF PPOPERN (S410WN BELOW nR ATTACN TWO COPIES� <br />�or e�ocK oF <br />PARCELTA%I.O.NOMBER <br />CONSTRUCTION LOAN LE1 <br />WATER <br />DRAIN <br />8 DISP <br />T% <br />!TEM <br />SUB <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK RFAF SETBACK <br />USEZONE LOTAFEA <br />ttPEOFLON51. NO.OFSTORIE� <br />SIZE OF BLOG. FIRE SPRINKlERS REO'0 <br />......��.,..����nen FIREALARMFEOD <br />INTAKE BY <br />�re <br />CIN ZIP <br />CITY ZIP <br />CIN ZIP <br />�_ <br />�ESETBACK <br />PHO <br />CONTACT PERSON h4D PHONE N0. <br />LICENSE p <br />LILENSE p <br />�I� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLIGATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROV!SIONS 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 PRUPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS :AW 18.27 ti�`.N AND 296200 WAC. <br />���- ��1 3 /n /9 t- <br />pATE <br />$IPNAIUfiE <br />...��.."."__. __ � <br />Np, TYPE OF E�UIPMENT FEE <br />FOR�ED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />FAN <br />WOOD STOVt <br />METAL FIREPLACE <br />FIREPLACEINSERI <br />HEAT PUMP <br />GAS PIPING <br />ExHAUSTFAN <br />TOTAL $ <br />PLANClE/2��1/� I FE//!%�.tJ�/ <br />❑ YES ❑ NO gUILDING <br />aaeu+cr xoaoweuixeuxns <br />�PWP PLUMBING <br />BnSEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STA!E BUILOING SURCHARGE <br />CITY OF EVF.RETT PUBLIC WORKS <br />LOCAL SNLES <br />TAX CODE IS 3105 rora� _ <br />