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APPLICATIP'V FOR CONSTRUC7�4N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC S0 S� i <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �ECHANICAL ❑ PLUMBING ❑ SIGN <br />AFCHRECT OR UESIGNEP <br />GENEML CONTFACTOR <br />'LUMBING CONTPACTOR <br />GONTPAGT PflICE O�RN <br />� <br />DESCRIBE W� <br />� MAILADUHESS <br />✓r E /�/�/ <br />MRILADDPESS <br />AIAIL AOORESS <br />MAIL ^DDRE55 <br />- i / .- <br />)�OO <br />INVOLVED <br />dTV ZIP <br />CITY 21P <br />CITV 21P <br />CIN ZIP <br />� - 6iNg,vE�S`�f^ SePtf/ ^�f/s <br />CITY ZIP <br />�av e_ J U� 1� <br />CONTACT PEFSON AND PHONE N0. <br />PflOPOSE� USE OF BUIL�ING <br />LEGAL DESCRIPTION pF PROPEFTV (SHOWN BELOW OR ATTACH TWO COr'�ES� <br />LOT BLOCK OF — <br />PARCELTAXI.D.NOMBER <br />TELEPHONE NUMBER <br />PLUMBING <br />0. TYPE OF PIXTURE OR ITEM <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR. ETC.1 <br />SUB TOTAL $ <br />FEE <br />PMONE <br />PMONE <br />PHONE STATE LIGENSE Y <br />S- y�roqN�/ rr� <br />PHONE STATE LICENSE R <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THF. <br />OWNER OF THIS PRUPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />A/C-A/HNDLG 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 />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSE7BRCK SI�ESETBACK PLANCHECKNUMBER <br />NPE OF CONST. <br />SIZE OF BLDG. <br />OCCUPANCY�OAD <br />RE�ASOiN- /� �/' <br />�I� "" � <br />INTRKE BY <br />3q�5 <br />LOTAREA VACANTSITE FEES <br />❑ YES ❑ NO BUILDING <br />NO.OFSTORIES Utcu�u�cr rm.arMv[ui�:cuxns <br />6 <br />snouc PLUMBING <br />2 � <br />FIRESPHINKLERSREOD BASEMEN� MECHANICAL <br />�'f'� ❑ YES ❑ NO <br />FIREALARMREO'D MEIGHTLIMITATION ADDITIONALPLANCHECK <br />�— <br />STATE BUILDING SURCHAi <br />PLANS APPROVED OV CITY OF EVEflETT PUBLIC WORHS <br />iJM/ LOCAL SALES <br />DATE .Z// y/p+� TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT $ <br />FEE <br />�n � <br />FEE <br />