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APPLICATWH FOR CONSTRUCOON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />259-8810 <br />f 1 DEMOLITION 1-.I COMBINATION I 1 BUILDING ;AECHANICAL ❑PLUMBING fl SIGN <br />(DARNER MAL ADDRESS <br />1FNANT MALACMEBS <br />AKNVECI OR DESIGNER WL ABOBESS <br />GENERALCONNULTOR MALADDIRESS CITY ZIP "PONE sNRA Linn . <br />CONTRACT MrA ol <br />/o ,y <br />W W <br />DESCRIBE IMORK AND SOOME FCOTAOE fNOLVEO <br />Cp1C TpE115D1 A1q Nl If. L <br />r <br />I HVERLBY 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 />PERFORMANCE 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />q <br />x <br />pBorosEo a DrLD <br />LEGAL UESCR ITCH OF PROPER" (STIOYYN KILONOR ATTACH TAOCOPIES) <br />tor— BLOCK OF <br />JAoprtF•/ss[. <br />CDLRTPUCTK]N LOAN IENpCR. iIELfPIIDhWNWBkR <br />- u6 <br />PROJt= ADDRESS <br />-- -oi gockftg"n- u <br />L,I.N,WAeIK,NNKe <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—AMNOLG UNITS—H.P. <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS—BTU.75 M EA. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING FLEWCE- I ' <br />T <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SU7 TOTAL f <br />SUB TOTAL f <br />_ <br />PERMIT S <br />PERMIT f <br />TOTALFEE $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FROM SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />(61757� <br />FEE <br />RECEATW <br />ELSE ZD+E <br />LOT AREA <br />VACANT SITE <br />fl YES f l NO <br />FEES <br />VALUATION <br />I FEE <br />BUILDING <br />PLUMBING <br />TYPE D CUMSt <br />NO Of STORIES <br />q.Fwc. <br />c� <br />NJ NIAH1lNG INnI <br />SIEECEBLDO <br />PRE SPRINKLERS PLOD <br />BASEMENT <br />D YES fT NO <br />MECHANICAL <br />— <br />ADDITIONAL PUN CTIECK <br />DCCUnANCYLOAD <br />FIRE ALARM PLOD <br />NEXHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SLIRCIURGE <br />�— <br />INTAKE BY <br />PLANS AnPeovfDe`' <br />DATE <br />CITY OF EVEflETT <br />LOCAL SALES <br />TAl(COBE IS 3705 <br />puBL,a WORKS <br />TOTAL <br />