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APPLICATIQ^ FOR CONSTRUCTC�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />A <br />HEATING SYSTEM� ❑ G <br />BUILDING DEPARTMENT C\�� • AS ❑ ELECTRIC p <br />259•8810 <br />i=l DEMOLITION (�COMBINATION f;l BUILDING I� MECHANICAL f_� PLUMBING ❑ SIGN <br />OWNER MAILAD�PE55 <br />F 7r L ,s?/ 3/ -/06' �� <br />TENANT MAIL A�ORESS <br />ARCHrtECT OB,/�ESIGNER �� MAIL ADD'JRESS�J <br />G'IQ/Jf/ 1%%N�/¢'w L�G <br />GENERALCONTRACTOR MpILADDRESS <br />MECHpNICAL JNTRRCTOF M�IL AD�FE55 <br />PWMBMG.ONTR�CTOR MAILpDDRESS <br />//5�/l.e�+ 7/fo✓SI../IJ <br />CONTRACT PRICE OF WORK <br />�r C'�/ " s, F, il� ✓ s� <br />DESCRIBE WORN AND SOUARE FOOTAGE INVOLVEU <br />LEGAL <br />%!'J� /�iG� <br />SEp USE OF BUIl01NG <br />CITY <br />� G-i�.� <br />CITV <br />/ CITY <br />L �r.�� <br />CITV <br />P. <br />' PROPEfl'TV''(,S'H/OVM BELOW Ofl ATTACH TWO COPIES� <br />BIOCK � pF <br />s:3i 7�'s' dd y d�o s o <br />PARCELTAXI.D.NUMBER <br />CONSTRUCTIONLOANLENOEP,�ODRESS.TELEPHONENUMBER <br />PLUMBINO <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK REARSETBACK <br />USEZONE LOTAREA <br />TVPEOFCONST. NO.OFSiORIES <br />SRE OF BLDG. FIRE SPflINkLERS REO'D <br />OCCUPANCY LO�D FIRE ALARM REOD <br />PEASON <br />INTAKEBV PLANS�AAPPROVEDBY <br />onte /o%'/ql� <br />QTV <br />/ <br />ZIP PHONE <br />d 9.s'L �� 3 ; <br />Z�F FMONE <br />ZIP <br />PM3oN7 <br />7/ � 7 <br />21P PNONE STATELICE E� <br />ZIP PHONE STATELICE�SLI <br />AND PHONE NO <br />�/fP/ .tz7- <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 />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROrtRTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X/Z ��� 5�1 f�� <br />SpNAT11RF O�TE <br />FEE NO. TYPE OF EOUIPMENT <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 />--�- <br />� RANGEHOOD <br />; WATER HEATER <br />� WOODSTOVE <br />' METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />� GAS PIPING <br />SIDE SETBRCN � PLAN <br />C YES ❑ NO BUILDING <br />OCCUwNtr NoapWELLiHcuNiiS <br />ccouo PLUMBING <br />BnSEMENi MECHANICAL <br />❑ YES f� NO <br />HEIGMT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />PERMIT $ � <br />TOTAL FEE $ <br />FEE RECEIPTNO. <br />VALUATION FEE <br />��' '� <br />i <br />i <br />i <br />� <br />i <br />