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APPLICATIQ�' FOR CONSTRUCTr"'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM� <br />BUILDING DEPARTMENT • O GAS p ELEC7RIC ❑ <br />259-8810 <br />❑ DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL LUMBING ❑ SIGN <br />OWNEF MAILADDflF.SS CITY ZIP PHONE <br />�' <br />�c� ti� � i�i�r,�s ,p�r����s'��.s^,r 9��n� 25'� 3 5 SI <br />MAILADDRESS CITY ZIP pHONE <br />ARCHITECTORDESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERALCONTRACTOR MAILADDRESS f.ITY ZIP PHONE STATELICENSEI <br />MECHANILRL CjNiTRACTOR MAIL ADDRES CIN ZIP PHONE STATE LICENSE t <br />/ / <br />� / 1 I 1 I I <br />PLUMBINGCONTRR TOR MAILADORE55 <br />()l/ +Y�'P � <br />CONTqACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE fOOTAGE INVOIVED <br />� <br />� PROPOSED US F BUILDING <br />LEGAL DESCRIPTION OF PPOPF <br />LOT BLOCK <br />PARCELTAXLD.NUMBER <br />CONSTRUCTION LOAN LENDER, AODRESS, <br />OF <br />TYPE OF FIXTURE OR <br />WATEH CLOSET (TOILET) <br />BAiJ�7{iC" <br />LAVATORY'(WASH BASINI <br />LAUNDRYTRAV <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--FAINLEAC <br />SINK (SERVICE—BAR. ETL <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAfl: <br />USE 20NE <br />neE aF coNst. <br />SIZE OF BLDG. <br />OCCUPANCVlOAO <br />REASON <br />�NTAH[ OY <br />TOTAL FEE <br />LOTAREA <br />NO. OF STORIES <br />FIRE F;'flINKLEFS REO'D <br />FIRE ALARM qE0'D <br />PLANS APPROVED 6V <br />DATE <br />PHONE <br />PHONE NO. <br />6 <br />1 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 ANU 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 qNY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTqACTORS LAW 18.27 RCW AND 296.200 WAC. <br />!� - � /� � <br />�L�1 <br />fVC—NHNDLG UNITS—H.P. <br />FORCED Alfl SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL F�REPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />E� <br />SIDE SETBACK I PIAN <br />VACANT SITE FEES <br />❑ YES O NO 9UILDING <br />O[WVAHLY NO OfpWFLLIHGUNIiS <br />tnouo PLUMBING <br />BnSEMeNT MECHANICAL <br />�] YES ❑ NO <br />HEIGHT I IMITRTION ADOITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEI;ETT PIIBLIC WOPKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />TOTAL $ <br />FEE <br />� <br />i <br />Yy <br />H <br />