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APPLICATIC , FOR COHSTRuc,rf " )N PERMIT <br />1 TO BE COMPLETED IN BLACK INK —PLEASE PI IINT 04L <br />IlMilill <br />1 <br />r <br />BUILDING DEPARTMENT L HEATING SYSTEN.. J GAS G ELECTRIC 'J <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />J( BUILDING <br />I I MECHANICAL <br />PLUMBING i I SIGN <br />OWNIiR <br />Tgc 130�1,jc, <br />MAIL ADDRESS <br />ra ,'}7oe")c a"/Y <br />CITY <br />MIS oN-IZ(15cz177- <br />ZIP PHONE <br />,!✓/I.9[/'Z, <br />264-3s 47 <br />TENAANT <br />p <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCWTEC70R DESIGNER <br />QG` V <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />t"m 12,.; /N/ <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />2R PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />CONTRA'T PRICE OF WO <br />30, ,To0 <br />DESCRIBE WORK AND SQUARE FOOTAGE .INVOLVED <br />CONTACT PERSON AND PHC NB NO <br />(C.C.f�l1-r-A ,a'aL 1`✓Ll ��•r �L" F jl=�� <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 GOVFRNiNG 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 I.CICAL '_.AW 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 19.27 RCW AND 296.200 WAC. <br />I; <br />P OPOSED USE. OF ATLDING <br />D A-'r-(G E A? C - <br />LEGAL DESCRIPTION OF PROPS TY (SHOWN BELOWOR ATTACH TWO COPICSI <br />LOT BIQCK OF - <br />- <br />-- <br />PARCEL TAX I D NUMBER <br />CONSTRUCTION LOAN LENDER ADDRESS. TELEPHONE NUMBER <br />SS PrECT AD E1_-N <br />7,.X3 U, I�A..i /,vG /Z-73 <br />M ATUnr <br />Dc <br />- <br />CRY BUSMLSSLiCINSr IY) <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AIHNOLIi UNITS-H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS -B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />_ _ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAIJ_ <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />T <br />SUB TOTAL $ <br />SUB TOTAL $ <br />_ <br />PEIMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />_ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />G YES fl NO <br />FEES <br />VALUATION <br />BUILDING <br />-- <br />PLUMBING <br />/JFEE <br />[ �f� Jz <br />-- <br />TYPE 0I CONST , <br />�_ /v <br />NO OF STORIES <br />% %A <br />mcupw <br />°� ° <br />NG 0GMHING UNITS <br />SIIE OF BLDG <br />Q S7FT. T.I. <br />FIRE SPfiINKLERS REOD <br />/!!) <br />BASEMENT <br />_ . YES"-' NO <br />MECHANICAL <br />' <br />—� <br />ADDITIONAL PLAN CHECK <br />— <br />OCCUPANCY LOAD <br />37 <br />FIREALARM/REOD <br />�X f'i <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />/ 15 <br />INTAKE BY <br />PL�+ S APPROVED BY <br />//N <br />�D ,E / 7 , Y J <br />CITY OF EVEBETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />2 Y7 i <br />.0 <br />