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- APPLICATIQ ; FOR CONSTRUCT: )N PERIIAIT y�y� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> ��.�., <br /> BUILDING DEPARTMENT HEATMG SYSTEM: ,j GAS iJ ELECTRIC iJ � <br /> 7.i9-8810 <br /> DEMOLI710N : I COMBINATION _ BUILfii�dG i MECHANICAL ❑ PLUM8ING ' SIGN <br /> O1V N q 1 AR ADDPE55 �1 I I v CIiV A ✓1 ZIP . t fnONE <br /> L.��_L, i� �� ll-��\���lQ t�`� /V� . IJIU�q--C�10 r�'� dJW l�VPft�l- -I��y,il <br /> TENnNT 11LAUDf�FSS GTV ZIP pHONE <br /> ARGNREGTORD3IGNER MAILADDRESS CRY ZIP PNONE <br /> GENEAa�_CONTRqCTOR MAII.ADDRE55 CIiY 21P- c�tr NE STNEUCENSE� <br /> J<<l � t� � ���1��� �'�' �l� �- ���Y. r�K�',°�9��P (�KcS-fSyO� KL�n[ir�Yrn�� <br /> 4ECN4NICALCONiRACTOR 1AAlI.ADDflE55 CITY 21P PHONE STATELILENSEr <br /> PLUM9ING CONiRApTOR MA�1 AGDAESS CITV ZIP PHONE SiATE UCENSE/ <br /> CONTSACT PRICE OF WORK <br /> cl ^�`^QQ <br /> �� iL.l <br /> DESCRIBE WORH AND 501 ARE FOOTAGE INVOLVE CONiACT PEFSON AN�PHONE N0. <br /> _���S�c r��[�r reinl'r , o m.�C }G _ <br /> 1 <br /> 1'S .`P ` <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED lISE OF BU�LDING <br /> S r � APPLICATION AND KNOW THE SAME TC BE TRUE AND CORRECi ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNiN(;THIS'fVPE OF <br /> LEGALDESCRIPTIONOFPqOPERTV'SiHOWNBELGWOfiATiACNTW000PIE5) WORK WILL BE COMPL6.!'ED WITH WHETHER SPECIFIED HEREIN OR <br /> �or B�a;K -. oF NOT. THE GRANTING OF A ?ERMIT DGES NOT PRESUME 70 GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> __._ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTflUCTION.THAT I AM AUTHORIZEfI BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> c�RceitnxioNumeeR — APPLICATION IS MADE AND I COMPLY 'NITH THE STATE <br /> ���j,�7Q �..,I� V �I�QO � I CONTqACTORS LAW 1827 PCW AND 296.2d0 WAC. <br /> "� <br /> GONSTRUCTIONLGnNL NDER.A DRESS.TELE9HONENUMBER � :�� � <br /> �` /�'� <br /> PROJECTADDRESS ,r i i -- p��� <br /> cirv ousiness uccr�sr uu '— <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A�C-0.�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—ftT.U. M <br /> _ SHOWER � CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> I;RINAL METAL FIREPLACE(WOOD BURNING) <br /> ' DRINKING FOUNTAIN ; FIREPLACE INSERT � <br /> FLOOR fIRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF URAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> I <br /> I <br /> I <br /> 1 <br /> _ SUG TOTAL S SUB TOTAL S <br /> PERPAIT $ PERMIT S <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSET9�GN pEARSETtlFCH SIOESETpACN P�ANLHECKNUMCER PEE RECEIPTNO <br /> usezoNe �oTanen vncantsiTe FEES VALUATION FEE <br /> ❑ YES . : NO BUILDING <br /> ��l �a � <br /> rvPE Of CONSt NU.OF S10RIE5 acurnncr r:o m o�ruu�„ur�irs <br /> �'p0p� PLUMBING <br /> SIZEOFBLDG FIFESPRINNIERSREO'D BASEMENT MECHANICAL <br /> i���. YES �-�. NO <br /> OCCUPANCVLOAp FIREALARMRE00 4EIGHTLIMIiAiION FDDITIONALPLANCHECK <br /> OTHEf� <br /> FEA]ON <br /> —i— <br /> STATE BUILDING SURCHARGE � �.5C) <br /> INiANE BV PIANSAPPROVED BV CITY OF EVENETT PUBLIC WORKS � <br /> LOCALSALES ---r— <br /> onre TAX CODE IS 3105 TOTAL �� - �C�J <br />