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APPLICATIO'� FOR CONSTRUCTt"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION !] BUILDING .��4N�ECHANICAL f� PLUMBING ❑ SIGN <br />GWNER MAILAOLRF.SS �j/�9 �,?'�, S'�.����YC�� ���0� PH033 7-06 y3 <br />�ci v� u n �1 �-t%� c'° r u L L <br />TENRNT MAILADDfiE55 CIiV ZIP PNONE <br />�aul.a po�se� /s2Gw4/ytitCvere�f-� 4'80'?0/ o?SS-�1s5�1 <br />-- -- CITV 21P PHONE <br />GENERRL <br />DESIGNEP <br />PRIGE OF WORN <br />i0 /�� <br />IORK �ND SOl1ARE <br />cirv <br />CITV <br />�at <br />LEG�P EDUnSEOFBUILDING <br />�1��'T�OFPROPERiVISMOWNBEIOWORRTRCHTWOCOPIES) <br />LOT BLOCN OF <br />P�RGELiA%ID.NUMBER <br />COPoSiRUCTqN LO�N lEl <br />NATER CLOSET (TOILi <br />3ATHTUB <br />.A\'ATORV (WASH BA: <br />SHOWER <br />KITCHF.N SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETB� <br />USEZONE LOTAREA <br />T1TEOfCONSi. NO.OFSTO <br />SIZE OF BI�G. FIRE SPRMF <br />OCCUPANCYLOAD FIREALAPM <br />PUNS r1PPflOVED BY <br />DATE <br />$ <br />$ <br />$ <br />Z�p PHONE <br />Z�p PNONE <br />�1�� � <br />Z�p PIIONE <br />/�/�R� <br />CONTACT <br />� <br />STpTEUCENSE• — <br />� Cl.cnp �o• <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIM OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESJME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFGPA.!ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOIi WHICH <br />APPLICATION IS MADE AND I COMPLV WITH TNE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x �aulla�and¢�./ �//0/93 <br />SIGN�iUBE 061E <br />AIR SYSTEMS—B.T.U. <br />�TFR.S—B.T.U. M <br />FAN <br />RANGE <br />WATER <br />?UMP <br />�IPING <br />UST FAN <br />SIOE SETBACK PLAN CNECN NUMBEN FEE <br />VPCANT S�TE FEES <br />� ] YES ❑ NO BUILDING <br />acuPsxc xaaov.nuxcuers -- <br />�°Wv pWMBING <br />OnSEM�HT MECHANICAL <br />r'. YES Ci NO <br />HEIGMTLIMIT0.fION ADDITIONAL PLAN CHECN <br />OTIIER <br />S7ATE BUILDING SURCHARGE <br />CITY OF EVEHETT FUBLIC WORKS <br />LOCRLSALES <br />TAX CODEIS 3105 TOT�� <br />