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APPLICATION FOR CONSTRUCT�ON PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �HEATING SYSTEM: ❑ GAS � ELECTRIC O <br />259-8810 <br />17 DEMOLITION ❑ COMBINATION ��] BUILDING ❑ MECHANICAL ❑ pLUMBING ❑ SIGN <br />OWNEfl MAILAODRESS CIiY ZIP PHONE <br />J,IAni� �;"l"� �',/'trr��, nd: r"�)P!s'i-, 9S1o� �'t.?� '% l) <br />�J <br />MRIL �OORE55 <br />CITY ZIP <br />RRCHITECTOR�ESIGNER MAILADORESS CITY 21P PHONE <br />��INN��:.` �-CC.u1� v��icN7r5t c'[. rl,��L/� �:� `i�2SF, .",.��� ���.N �� <br />GENERI�I. CONTflACTOfl MRIL �ODRESS CITY ZIP PHONE STATE IICENSE / <br />.i U�f�-F' (�./'P_�!tu%,c'D��.iC `�c,-2>f-c.,�ce�c-.rt�� �c�Ei£iT 9�� i 2-� 7-cl2z �c�ati�f CY' IO�KF <br />MECHANN:pLCONTRACTOR MAILPODRESS CITY ZIP PHONE STATELICENSE� ' <br />PWAIBINCaCONTflACTOR MMLADDRE55 CITV ZIP PHONE ST�TELICENSEI <br />CON7PRCT PflICE OF WOflN <br />fl--,� ,,. � <br />� �,r.r.� — <br />DES IBE WORN ANU SOl1�RE FOOTpGE INVOLVEO CONTACT PEHSON AND PHONE N0. <br />-f_i��t�i =fi /_IiG�K.�J .kdi,� :� �;. �'/I�9����rn'r'9 7:;9� ?. i7_7 <br />PROPOSE� IISE OF BUILDING <br />/ -' lEGALDESCRIPTIONO OPE <br />` lOi BLOCK <br />� �, / _ G <br />/� <br />PRRCEL %ID.NUMBEF — <br />2 <br />CONSTPUCTION IORN LENDEfl. <br />PRWECTADDRESS /, <br />I HEREBY CERTIFY THAT I HAVE �READ AND E%AMINED THIS <br />���`� APPLICATION AND KNOW THE SAME TQ BE,TRUE AND CORRECT. ALL <br />PROVISIONS-OF LAWS AND ORDINANCES GOVERNIN(3 THIS TYPE OF <br />�SHOWNBELOV/ORATTACHTWO WPIES) WORK�WILL BE COMPLETEO WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO QIVE <br />oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEqFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRE� 9Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />,. �,�-f/-f ? C�LRACTOfiS LAW 18.27 FjQW AND 296.200 WAC. <br />R�ORESS,TE EPHONE <br />TYPE OF <br />WATER CLOSETi <br />BATHTUB <br />LAVATORY(WASf <br />SHOWER <br />URINAL <br />PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRCN75ETBRCK REAqSETOACK <br />� F �+: i I I :j, <br />USEZONE IOTRflEA <br />� <br />IYPEOftONSi. NOOFSTORIES <br />�� I <br />SIZEOFBIDG. FIRESPRINNlERSREO'0 <br />S/ JtJ GY n/n <br />REp50N <br />INTAKE BY <br />FIAE RLARN REOD <br />�A,� :5 /i8/S 3 <br />$ <br />$ <br />S�OE SETBqCK <br />,— i <br />[l YES ❑ NO <br />wwxr coao,nwxcururs <br />G YES ❑ NO <br />EIGHI LIMITATION <br />�7J 7 <br />CITY OF EVEflETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />NO. <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />cu -� <br />PIAN CIIELN <br />BUILDING <br />PI.UMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTMER <br />STATE DUIL�ING SURCHAFGE <br />Pt18LIC WOFKS <br />TOTAL <br />B.T.U. M E.A. <br />M <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEE C <br />� j�G-O <br />S <br />T <br />7�� <br />2��� <br />