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APPLI�CATIC-`I FOR CONSTRUCT"71�i PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEAT ING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ C�MOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING C 1 SIGN <br />O R MAIL ADDRE55 GTV IP PHpNE <br />d� �-e ✓ �oo/ Lo� �u� Sl-'� ��/a-/ �/�,'/ ' �090 <br />TE /�pII ] � MAIL pD�RESS � GITV ZIP PMONE <br />ARCHITECTORDESIGNER /fA1AILdDDRE55 .,J CITV ZIP PHONE <br />�� <br />GENE�AICONTPAGTOR MAILRDDRESS CITV 21P PHONE STATELICENSE� <br />CONTRACTOfl _ MA'L ADDRESS <br />PLUMBING <br />LONTHACT PRICE OF WORK <br />MAIL ADDRESS <br />DESCRIBE WORK �NO SOUARE FOOTRGE INVOLVED <br />PROPOSED USE O� BUILUING <br />LEGAL DESCRIPTION OF PROPERTV ISMOYrtJ BELOW OR ATTRCH TWO COPIES) <br />LOi BLOCK OF <br />PARCELTAXLD.NUMBER <br />CONSTRUCTION LOAN LENDER. �DDFESS. TELEPIIONE NUMBER <br />PROJECT ADDRESS n <br />/ �� � ��� I <br />NO. <br />WATER CU�SET <br />SHOWEF <br />KITCHEN SINK 8 DISP <br />LAUNDHVTRAY <br />CLOTNES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />ROOF DRAINS—RA�NLEADERS <br />FOR OFFICE USE ONLV: <br />fRONTSETBACK REARSETBACK <br />USE ZONE <br />iVPE OF CONSi. <br />SRE OF BL�G. <br />OCCUPANCYLOAD <br />REASON <br />INTr1KE BY <br />PERMIT <br />TOTAL FEE <br />NOAF STORIES <br />FIRE SPRINKLERS REO'D <br />FIPE ALARM REOD <br />P�pNS APPROVGD OV <br />DATE �17J7.�I I� <br />CITY ZIP PNONE STATE LICENSE � <br />FEE <br />UCENSE t <br />CONTACT PERSON AND PMONE NO. <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 WHETHEFl SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />CTHER STATE OR LOCAL LAW REGUUTIN(i 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 />hPPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br />X � a�%"CJ/ <br />SbN.UURE OAR <br />� <br />UNITS—H.P. <br />VSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.1 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />R4NGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SEIBACK I PLANCHECN <br />VACANT SITE FEES <br />G VES ❑ NO BUILDING <br />acuP.xcr xoaownuxcuxns <br />cnow PLUMBING <br />oASEMENT MECHANICAL <br />i l VES ❑ No <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAI <br />CITi Of EV�4ETT PUBLIC WORHS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />M <br />� <br />�— <br />; vv <br />• <br />' V '�'''��e:_ <br />�, <br />y,. <br />'`;�,:: � ��. ' <br />_.�:,•, <br />`�, {�' <br />_...y <br />ti-: ':.;y'P <br />`iY`f <br />r' i <br />�' � �i <br />. . �, �.;'ra Y. <br />.L� <br />� •.,�..� I ��� <br />- _ ::��.,�.��}t <br />_ �.. ,ir4'1� <br />�.. �, � <br />:,�..., ;�. <br />� �„�,ei.^�;�}.[' <br />',''!��_:1 . <br />.;�� <br />-,1t+N <br />� �. <br />'4' <br />. ' �,'' <br />