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APPLICATIC� FOR CONSTRl1�;T�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION l� COMBINATION ❑ BUILDING <br />OWNER MAILAOORESS �Z�%O CITV <br />i�l-2xZy' N/r�l S�2o S.E �v. M�c� wy �E <br />❑ MECHANICAL ❑ PWMBING �SIGN <br />ZIP PHONE <br />9�Zo8 <br />TENANT MAILADDRESS CITV ZIP ��/�(,Z'j PHONE <br />fll.�X u�'d�1Z�2 620 SE �RE� mAU. i,✓�a+.1 L-V�IZC'(( WA 5u,7� `l� iG[�- 513-1�`i' <br />ARCHRECTORDESIGNER MMLA�DRESS CIN 21P PMONE <br />QUIKNL� 5!(;�NS 6�z� tiV��w14y �V"aG�f u�k ��3 7ov-353-55ti� <br />GENERALCONTflAC�R MAILADDRESS CITV ZIP PMONE S7ATEUCENSEp <br />(����� �IbN7rNG Z��((U W SCotTi'EN AEU,�Gio�.l �18223 �13rj-20'i4 DWGS�M o7'i�L <br />��vrueuire� cnuraectna MAILA��RESS CITY ZIP PHONE STAiE�ICENSEp <br />P W AIBING CONTRACTOR <br />PRICE OF WORH <br />��CRIBE WORK AND SOUPRE FOOTAGE INVOWED <br />S � l�iJ �G� f.3�lic o�i✓G <br />CITV 21P <br />3C7 SQFi . <br />PROPOSED USE OF BUILDING <br />%ZCr% A1/2�9i✓� <br />LEGAL DESCFIPTION OF PROPERTV (SHOWN BELOW OR ATTACH TWO COPIES� <br />lOT BLOCK OF <br />PAPCELTA%I.D.NUMBER <br />CONSTRl1CTION LOAN LENDEP, ADDRE55. TELEPHONE NUMBEP <br />PROJECT ADDRESS �7 <br />ro3vSE � //la/l <br />PLUMBING <br />NO. TYPE OF PIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <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 />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />conurccrweru REARSETBACK SIOE <br />USE ZONE <br />L -1/2 <br />TYPE OF COt157. <br />SIZE OF BLDG. <br />OCWPANCV LOAD <br />FEASON <br />INTAKE BY <br />•LUTAREA `, <br />�r <br />N0. OF STORIES <br />FIRE SPRMKLERS REO'D <br />FIfiE ALAPM PEOD <br />PLANSA; PjiOVEDBV <br />Il <br />DATE I r_ _�t, 4� <br />STNiE LICENSF p <br />�-25 Lir-Soe�2 353-55y7 <br />CONTACT PERSON AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT. 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�MPLY WITH THE STATE <br />CONTRACT9RSLAW7Q(1'%RC}E�AND 2011,WAC. <br />NO. <br />OF EOUIPMENT <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />VACANT SITE �«� <br />❑ YES Cl NO BUILDING <br />occuvnr.cr xoovmvewxemu�s <br />�fl0°P PLUMBING <br />oASEMeNi MECHANICAL <br />❑ YES ❑ NO - <br />HEIGHTLIMITATION ADDITIONAL PLAN CHEG< <br />�L�'J� OTHEF <br />STATE BUILDING SUFCHARGE <br />CITY OF EVEHETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 rora� <br />f? Zc�- y � <br />�� onr <br />FEE <br />M E.A. <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTALFEE 5 <br />FEE _ , � � <br />�rT L. <br />�p <br />tl <br />�N <br />M <br />� <br />• <br />