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i.�',l l� ( <br />APPLICATIQN FOR CONSTRUCT�4N PERMIT � <br />TO BE GvnIIPLETED IN BLACK INK—PLEASc PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS 0 ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING <br />MAIL ADDRESS <br />. n <br />❑ SIGN <br />CITV ZIP PHONE <br />.�Lj. eet .� ._ � �. <br />TENANT fr M�ILADORESS CITY ZIP PNONE <br />V <br />ARCMITECTOPDESIGNER MAILR�DRE55 CITY 21P PHONE <br />GEN:RPIr,pryTg�C70H MAILAODRESS CITV 21P PHONE STATEIICENSEf <br />�I� 0. <br />MECN IC�LGONTRACTOR MAILADDRESS CITY 21P PHONE STATELICENSEI <br />PLUMBINGCONTR�CTOfl MAIL�ODRE55 CITY ZIP PHONE ST/,TEIICEN5E1 <br />CONTMCT PRICE OF WORK <br />>��SoDtO� <br />DESCRIBE M/ORK ANO SpU RE FOOTAG NVOL ED <br />� ('�!A_Q Q�A A� 11A4�Y <br />PqOPOS�D USE OF BUILDING <br />IEGAL E CRIPTIONOFPqOPE <br />LOT BIOCK <br />BELC�' OR ATTACM iW0 COPIES� <br />— OF <br />P�RCELTA%I.D.NUMBEfl <br />CONSTRULTION lWN tENDEH. �DDPESS, TELEPHONE NUMBER <br />PROJECTADDRESS <br />ct 3D —�s 3 a- P.r.Q <br />PLUMBIN6 <br />NO. TYPE OF FIXTURE OR ITEM <br />a WATER CLOSET (TOILE� <br />BATHTUB <br />a. LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEH <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEflS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR, ETC.) <br />SUB TOTAL $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK AEARSE7BACK <br />USEZONE LOTAREA <br />7VPEOFCONSC r10.OF5TOflIES <br />SIZE OF BLDG. FIRE SPRINNlERS HEO'D <br />flEA50N <br />L040 I FIflE AUR61 REO'D <br />PLANS APPROVED BY <br />DATE <br />CONiACT PEfl50N AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIUN 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 PFESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFi THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFlOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS A4ADE AND I COMPLY WITH TFiE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />,. �r���, � `� � �3 ( 9`� <br />MECHANICAL <br />FORCED AIR SYSTEMS-B.T.U. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />VJOOD STOVE <br />FIREPLACE INSERT <br />HEAT PUMP <br />FXHAUSTFAN <br />SIOESETBRCK � PIANCHEGKNUMBER <br />VnCANT 5�7E FEES <br />❑ YES ❑ NO BUILDING <br />OCpIVAKY NOqPKlU4LUMIIS - <br />LR011° PLUMBING <br />BnSEUENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />TOTAL S <br />RECEIPT <br />FEE <br />X <br />� <br />�y <br />H <br />