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APPLI��►71Q�`' FOR CONSTRUCT�"1N PEF3MIT� <br />1'O BE COMPLETED IN BLACK ItJK—pLEASE PRINT �����r�err <br />BUILDING DEPARTMENT �— <br />259-8810 <br />❑ DEMOLITION �I COMI3INATIGN <br />OWNER ednn ennov�:—� <br />MF�L <br />ll�i' rU� • <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />G BUILDING <br />CIT'; <br />,, Q �� <br />�— CIiV <br />❑ MECHANICAL <br />Z�P PHONE <br />ZIP <br />PLUMBING I J SIGN <br />.__....__._...,.,,...�.�.. r.�ri�nwncaa CITY ZIP PHONE ' — <br />GENERALCONTRACTOR MAILA�DRI3SS CITY ZIP PHONE � <br />T iAY1 � SV� . ` STATE LICENSE p <br />(Z,�c w�e�d <br />MECHANICALCONTRn::TOR IdAILAOCFESS CITY 21P PHONE <br />SIDTE LICEhSE a <br />PLUMUNGCONTRFCTOR MAILAD�BESS PHONE SiATELICENSEq <br />��� �l�.ow,la+n� �tiGbyNe�iSs+Ty (�dwav�P4fs�S3 �FsoZn361 L►9NG��aEl1$►28 <br />CONiRACT PRICE OF WORK <br />�ESCflIBE WORK AND SQUARE FOOTAGE I VVOIVED <br />0 <br />PROPOSED USE OF 9UILDING <br />LEGFL f1ESCRIPTION OF PROPEF.TV (aHOWN BELOW OR ATTACH TWO COPIES� <br />LOT BLOCN — OF <br />PAPCELTAXID.NUMBER <br />CONSTRUCTIONLOFNLENDEri.ADURESS,TELEPHONENUMBER <br />9�6 s� Evf. rrb.ii <br />TYPE OP <br />WATER CLOSET � <br />BATHTUB <br />SHOWEF, <br />KITCHEIJ SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DflAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETBACT <br />USE 20NE <br />tYPE OF CONST <br />SIZE OF BLDG. <br />OCCOPANCVLORD <br />REASON <br />INiAKE BV <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE S <br />LOTAREA <br />NO. OF STORIES <br />FIIiE SPRINKLERS HEO'D <br />FIRE hLARM REO-D <br />PLANS APPROVED BV <br />DATE <br />CONTACT PERSON FN��PFiONE N0. <br />I HEflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE A�ID CORREGT. 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 />AUTHORII'Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LP'N REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY iHE <br />OWNER OF THIS PROf ERT'/ TO PEHFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITIi THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />���Q ��� <br />�_!�— � <br />seHntune onr <br />NO. TYPE OF <br />A/G—A/HNDLG UNf <br />UNIT HEATERS—B.T.U. � <br />CLOTHES DRYERS <br />RANGE HUclD <br />WATER HEATER <br />NlOOD STOVE <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />YACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OCLUGANCY NpOfpWfLLIN6N11i5 <br />cnauP PLUMBING <br />onSEMENT MECHANICAL <br />f� YES ❑ NO <br />HEIGHTLIMITFTION �DDITIONALPLANCHECK <br />OTHER <br />STATE BUII.OING SURCHARGE <br />CITY Of EVEHETT PUBLICINOFNS <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAL <br />T.U. <br />d�:r' <br />FEE <br />--*— <br />_� <br />SUB TOTAL S � <br />PERMIT $ � <br />TOTALFEE S � <br />FEE REC'cInTNO. <br />VALUATION FEE <br />�r <br />i <br />�--1 <br />i <br />�T <br />i <br />i <br />i <br />