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APPLICATI�"� �$R Ci�NSTRUCT'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM� � � <br />BUILDING DEPARTMENT _ �) GAS � ELECTRIC J <br />259-8810 <br />I I DEMOLITION CI COMBINATION � <br />�H'NER MAl1.ADDRESS <br />���u.Y�n �,.�a� 1 �� l o� � � � <br />TENANi MAILAODRESS <br />ARCNITECTOROESIGNER MAILADDRESS <br />S�AMn� <br />GENERALCOHTRFCTOR MAILAODPE55 <br />�� <br />MECNANICAL CONTRACTOR MqIL AD�RESS <br />PIUMBiNG CONTRACiOR MFIL ADDR[55 <br />�I <br />CONTRACT PRICE Of WORK <br />btuNc�nr 'Q"�niP ,r_1 <br />DESCPoC: YfJRN qvp SOUARE FOOi�GE INVOLVED <br />LEGAI-0ESCFIPTION OF PROPERTV �SHONRJ BELOW OR ATTACN TWO COPIES� <br />ior e�ocK — or <br />PARCEITAXIO.NUMBER <br />CONSTRUCTION LOAN LEP <br />PLUMBING <br />NO. <br />BATHTUB <br />LAVATORY <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTFIES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DR:.IN <br />BACKFLOW PiiEVEN' <br />ROOF DqAINC—RAIN <br />FOR OFFICE USE ONLY: <br />FRONTSEiBAGY. REARSETBRCK <br />❑SE20NE IOTFREA <br />fYGE OF CONSi. <br />SIIE OF BLOG. <br />HE�SON <br />INTANE pY <br />SUB <br />FIRE SPRINKLEFS REO'D <br />fIRE /LARM RE00 <br />OPTE <br />APPROVEO BV <br />BUILDING <br />pT1' c � <br />� <br />QTI <br />CITY <br />CITV <br />GTV <br />CITY <br />w11 7 [I�1 <br />FEE <br />� J MECHANICAL <br />ZIP PMONE <br />i�- R�aOc ' <br />21P PHONE <br />Z�P PHONE <br />21P PryONE <br />ZIP PNONE <br />21P PHONE <br />CONTACT PERSON ANU PNONE NO. <br />f:; PLUMBING CJ SIGN <br />� <br />STFTE tICENSE � <br />STFTE LI�EASE • <br />STATEIiCEhSE� <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 />PERFORRIANCE 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 COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 6200 WAC. <br />����� �� <br />o�ie <br />CIiV BUSMESS LICENSE NO <br />FUC—A'HNDLG UNITS—H.P. T— <br />FOfiCEO AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRV[r^.S � <br />VENTILATION FAN � <br />RANGEHOOD <br />WATER HEATER � <br />WOOD STOVE , <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />CHECNNUlA9ER I fEE � RECEIPTNO. <br />VAGtlT SITE FEES <br />❑ YES =, NO <br />BUILDING <br />0.T114AHLY NPG'�1VELL�NGONi15 <br />ceouo pWMBING <br />oASEMEN7 MECHANICAL <br />❑ YES u NO <br />NEiGniuMITAnON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAR�E <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />