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APPLICATIO.. FOR CONST�iIJCT► JN PERMIT � <br />TO BE COMP�ETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ;�GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I-1 DEMOLITION �`I COMBINATION � I BUILDING %rAIECHANICAL I ipLUMBING ! SIGN <br />OWNEP MPiIADDHESS � CITY 21P PHONE <br />MAI�AODRE55 CIiY 2IP <br />AHLI9TECTOROESIGNER MAILADDRt55 CITV 2iP PMONE <br />GENERALCONTRACTOR �AI.ILAD�RESS CITY ZIP PHONE SiA7ELICEhSE• <br />MECH�NICRL CONTRRCTOR MAIL AODFESS d Y >IP PNONE STATE LICENSE � <br />S�.�vi e� f�C�yv�b �oYo� _ S�c✓ /�r/C 9� 2�s �sJ T��/4/ SL9-r�i,�o 9 qo � <br />PLUMOING CONTR�CiOR MAIL qDDRESS GITY ZIP PHCNE STATE LICENSB a <br />CLASS OF WORK <br />IJ NEW I 1 ADDITION kALTERATION <br />��� . o <br />CONiRRCT PRICE OF WORK <br />/D/ES/�CRI9[ WORN AND SOUAAE FOOTAGE INVOLVE� <br />�L �L/ �66��f.� G t .� .� <br />�ROPOSEDUSEOF L�ING <br />SF2 <br />LEGAL �ESCRIPTION OF PROPERTY (SNOWN BEIOW OR AT <br />LOT BLOCK _ . _ OF _ <br />PRQIECi ADDP[55 <br />� <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWEfl <br />KITCHEN SINK 8 DISP <br />ROOF <br />SINK ( <br />FOR OFFICE USE ONLY: <br />FRONTS`.TBACK REARSEiDACK <br />5R[OFBLOG. <br />OCCIIPANCY LOAD <br />REASON FOR SPRiNKLERS <br />iHinK[ ov <br />LOT AR[A <br />ivrE of CoxSr. PciuAl <br />NO.OFSTORI[S <br />FIPE SPRNHLERS PEC <br />r�na, nrrnw�o ov <br />��� REPAIR I I DEMOLITION I! WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />GONTACT PERSON RND PMONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />rouacoaiesi PROVIS;ONS Of LAWS AND ORDINANr�S GOVERNING THIS 7YPE OF <br />WORK WILL BE COMPLETED WITH WHcTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL L�W REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFiK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC iORS LAW 1827 RCW AND 29fi200 WAC. <br />)TAL $ — <br />f $ <br />FEE 5 <br />S��E SETBACK <br />VFCANT SITE <br />.— �o_,y_9 <br />FEE NO. TYPE OF EOUIPMENT <br />i A/C—AiHNDLG UNITS—H.P. <br />'� / FORCF.D AIR SYSTEMS—B,T.U. M E.A. <br />UNIT HEATFRS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILA710N FAN <br />RANGEHOOD <br />/ WATER HE�TER <br />� WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLnCEINSERT <br />HEAT PUMP <br />; G�S PIPING <br />� EXHAUSTFAN <br />PLANCNECNNU1A13ER � FEE <br />ouaowc <br />OCLOPANCY NO M VNFIUNGUN116 <br />�P°�r � PLUIdOING <br />BASE1AENi MECHANICAL <br />HEiGer uMrtnTioN ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY DF EVfRETT PUBL!C WOFKS <br />LOCAL SRLES <br />TAX CODE IS 3105 rora� <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />