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�............ <br /> APPLICATIO:�'FOR CONSTRU�`T`�''�`' PERNIIT e�e�ett <br /> rneE�e�g�e�n TO BE COMPLETED IN INK—PLEASE PRINT � <br /> C�iV OP <br /> eve rett HEATING SYSTEM: Cl GAS ❑ELECTRIC ❑ <br /> f3UILDING DEPARTMENT <br /> 259-8810 <br /> I I OEMOLITION f 1 COMBINATION )Z BUILDING � [7 MECHANICAL O PLUMBING ❑ SIGN <br /> OW�lEN MqI�ADOfiF.55 CITY ZIP PIIONE <br /> ��A�V �,aa��-s-r 1 53 i Nu�(t- E�c«#- N ��o/ 25Z -487 Z ,4: <br /> iFNM.S MAILADpRE$5 CITY ZIP PNONE a/ <br /> � <br /> AOCNITECTO�DESIG��ER MnILAGORE55 CIIY ZIP PNOpE <br /> GENEqALWNiRAGTOR MAILADOIlESS CITY ZIP PMONE LICENSEI ' <br /> �-eUn�sshuce B��ixas t47c5 '6roo�sinE FY. 5a.��oN�'s� 4iz90 33s-ivs� k��.U�i6-�aB�7 <br /> 1AECHnNICALCONTR4C10R M4ILADDRG55 CIiY ZIP PNONE LILENSE� <br /> PIUMBW6C�NiPACTOR M4ILAODRE55 QTY ZIP PIIOkE UGENSEI <br /> CLASS OF WOFK <br /> I_1 NEW I I ADDITION � I ALTEFIATION x REPAIfl I 1 DEMOLITION LI Yi00DSTOVBFRPLINSERT ❑ BUILDINGRELOCATION <br /> C CONnTRCT PEPSON AND PHONE NO. <br /> L01liRACiPPICEOFWORN �" Zv�� �� (� �V� - 3�5-/5�97 <br /> OESCRIOE WORN n1l0 SOUARE FOOiAGE INVOLVEC� � <br /> �axav cae�o� - �� ����D <br /> rnoroseou� I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> GA� OY f APPLICATION AND KNOW THE SAME TO BE TRUE AND COFFIECL ALL <br /> LEGaLDESC IPIIONOFPROPERtVI5110WN0ELOWOR�iTACI1fOUFCOPiBS� PROVISIONSOFLAWSANDORDINANCESGOVEHNINGTNISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior 14 iS�/� etocK _ a � oF l�� .,�r_�'A< < NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORI7; TO VIOLATE OR CANCEL THE F'ROVISIONS OF ANY <br /> OTHER ST�TE OR LOCAL LAW REGULATING CONSTRU�TION OR THE <br /> -- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MADE AND I COMPLY WITH THE �TATE <br /> CON?RACTORS LAW 18.27 RCW AND 296.200 WAC. /� <br /> SIGNATUAEOFCONTRACIORORAUiHORREDA�EN1' OATE �,�-J—pI <br /> X (�-i��(/�/ �r/ iYPNd/JJA�v[c=/�v,/,� <br /> vaa�cr aooness < <br /> �� /�lo — �v�e�r� AP�'��CANiS Clt�BlI5ME55 LICENSE N0.ANO BUSMESE NRMF <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITCM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�NHNDLG UNI7S—H.P. � <br /> BATHTUB � FORCED AIR S`.'STEMS—B.T.U. M E.A. ; <br /> LAVATORY(WpSH BASIN) —�— UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHESDRYERS �— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE FIOOD � <br /> LAUNDHYTRAY ; WATERHEATER ' <br /> CLOTHES WASIIER � WOOD STOVE � <br /> URINAL ' METAL FlREPEACE R CHIMNEY ; <br /> DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DFAIN HEAT PUMF � ♦ � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOFDRAWS—FAINLEAGERS —�— ExHAUSTFAN � � ' <br /> � <br /> SINK(S�RVICE—BAf1,ETC.) ; ' <br /> — � — <br /> i i <br /> — � — � <br /> i � <br /> � � <br /> SUB TOTAL $ ; SUB TUTAL $ ' <br /> PERMIT $ i PERMIT $ i <br /> —•— <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> fRONTSETBACK RE�RSETBALK SIDES[iflnCN PUNCHELNNUMBER FEE RECEIPTNO. <br /> �.sezoNe LOTnAEA vncn�+rsne FEES VAWATION FEE <br /> — BUILOING �'��] �"Y/� ori <br /> I1PEO�GON15.pLlOWRBIE iYPE0/CONSLM1CIU�t acNrena xoadMiuvcuani — i <br /> � � ��� �'LUM�ING i <br /> SIZf.OF OLOG. ND.oF 570li1E5 OAS[IdENT MECHANICAL � <br /> 2 sr= I A�� <br /> occUPAHCVLOno nnESPRNK�EnSnEa�O ��ElGniu4nnTlal ADDITIONALPLANCHECK <br /> i <br /> /V N� OTHEF � <br /> tICA50N F011 SPfiINKlERS <br /> S7ATE BUILOING SURCHARGE � <br /> mmkc nr PUNSAPPROVEDAY CITY OF EVEflETT ru�uC WOF�Ks ' <br /> 4,� LOCAL SALES *— <br /> TAX CODEIS 3105 rora� �� � <br />