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A�PLICATIC"�I FOR CONSTRUC7�'DN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />f � DEMOLITION i; COMBINATION <br />py,R.��q � ` �, MMIADDRESS <br />HEATING SYSTEM: <br />1 BUILDING <br />ciTv <br />❑ ELECTRIC ❑ <br />! 1 MECHANICAL <br />�1 \11 n+ <br />i I PLUMBINd I 1 SIGN <br />7�N�ry7 ILADOfiESS CITY ZIP PHONE <br />ARLMIfECiOi1DESIGNER MAILADDRE55 CITv ZIP PHONE <br />GENEML LONTAACTOR MAIL �DDRE55 CITV ZIP PHONE STATE LICENSE � <br />MEGlUNIGLC� MAILADURE55 CITV 21P PMONE ST�7ELICENSE• <br />p���Kq r,q�7q�7pp MAIL ADDRESS CIN ZIP PNONE STATE LICENSE � <br />( <br />i_ I ADDITION I_] ALTERATION !! REPAIR I I DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />� ry�) I i/� �I��JP.E.R� 1 PA EIAi rt �Q 1"Y�G/ <br />�or 1� e�ocK <br />� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�owon � �CN FWH COPIES) PROVISIONS OF LAWS AND ORDINANCES CiOVERNINf3 THIS TVPE OF <br />WORK WILL BE COMPLETED WRH WHETHER SPECIFIED HEREIN OR <br />oF — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTMORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATNfi 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br />y LAVATORV (WASH BASIN) /,� <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />. DISHWASHER <br />LAUNDRVTRAY <br />CLOTHE3 WASHER ,i <br />� <br />URINAL <br />i DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />� BACKFLOW PREVENTERS <br />� ROOF DRAINS—RAINLEADERS <br />� SINK (SERVICE—BAR, ETC.) <br />� SUB TOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFlCE USE ONLY: <br />FRONT SETBACK RE�R SET&1CK <br />�� ♦ �n � <br />�pryE LOT AREl1 <br />�� <br />OFCONTS.QLOW�bLE TYPE CONST.ACTU�L <br />-u � N <br />nc n� x, NO.OF STOi11E5 <br />�pFp FIRE SPRNKIERS REO'D <br />1SPRINI(LERS y�� <br />INTN(E <br />J <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS � <br />VENTILATION FAN <br />qAN0EH00D .i <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEV <br />FIREPUCE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN / _ <br />,�'_ �5'f <br />PWI CHEGK NUMBER <br />�_ 39a9� <br />BUILDING <br />ocwvr.wr xaaowewxcuxin <br />ea v PLUMBING <br />¢- <br />BASEMENT MECHANICAL <br />� ADDITIONAL PUN CHECK <br />HEIGMT LIMITATIOW <br />/ <br />CPfW"'—' ca <br />STATE BUILDING SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCAL SAIES <br />TAX CODE 18 3105 ?�TAL <br />PERMIT <br />� <br />3 <br />� <br />