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APPLICATIC"'1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION C] COMBINATION I I BUILDING i i MECHANICAL I_7 PLUMBING C] SIGN <br />OW'1ER A1RIL ADORESS qTY ZI� � NNONE <br />�1\�i,�',�Nco1.� �1��4G�i�S�cF��.. ��.l��F'Y� �1 �Z���- R'.'�`l\ <br />�An,��° � � <br />TENANT MAIL A�ORESS C�TV ZIP PNONE <br />RRCMITEGTOR DESIGNER MAIL RDORE55 CRY ZiP VNONE <br />��t� ZIP PHO4E STAiE LIGENSE • <br />GENERAICONTFACTOH MAILADORESS <br />MECNANIG�IGONTRRCTOB MRIL�DORE55 C�TV ZiP PHONE STRELICENSE• <br />PIUMBING COr1TRhCiOR MAIL ADORESS CITY ZIP PHONE ST�TE LICENSE � <br />CONTRRCT PR6E OF WORK <br />WORK AND� W RRE FOO7AGE <br />3�u� <br />LEGAI DESGNIPTbN OF PROPERTV ISNOWN BELOW OR ATTACN TWO GOPIES� <br />lp1 BIOCK OF <br />PPRCEIiR%I.U.NUMBER <br />%p� �nt"J' i ��%� <br />CONSTRUCiION LOAN LEN�ER. <br />fPE OF Fl)CTI <br />LOSET (TOIL <br />V (WASH 8A: <br />SINK & DISP <br />HER <br />'TRAY <br />i WASHER <br />3 FOUNiAIN <br />FOR OFFICE USE ONLY: <br />FRONi T ACK REq E B� <br />� ( <br />US IE LOT EA <br />� <br />TYVEOiLONSi. NOAF5T0 <br />SRE OF BIDG. FIRE 5�I <br />t <br />OfCUPRNL OAD FlPEALhRM <br />RERSON <br />INTRNEBY � �LANS <br />)TAL FEE 5 I <br />SIDE SF BACK <br />VAGP 1 SITE <br />- YES I �N6 <br />a,-��v�� xaaaw�.i <br />lxyw <br />K <br />REO'D BASEMENT <br />G VES -� NO <br />CITY OF EVEHETT <br />Bv � LOCIIL SALES <br />/jY/p TAX COOE IS 3105 <br />fANTAGT PEHSON AND PHONE N0. <br />i HEREBY CERTIFY THAT � HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OR�INANCES 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 COMPLV WITH THE STATE <br />CO TRACTORS LAW 1827 RCW AND 296200 WAC. <br />� � ��. 1�(� VF:Y <br />scnnun oeir <br />OF <br />FORCED AIR SVSTEMS-B.T <br />UNIT HEATERS-B.T.U. M <br />RANGE <br />WATER <br />WOOD <br />ME?AL <br />NEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAI 8 <br />PEiiMIT $ <br />TOTALFEE 5 <br />FEE � REGEIPi NO. <br />BUILOING MI� 1S <br />PLUMBING � <br />MECHANICAI � <br />ADDITIONAL PLAN CHECK <br />OTHER i <br />STAiE BUILDING SUFiCHAHGE <br />PUBLIC WORNS <br />TOTAL i <br />� <br />