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i <br />APPLICATIC-1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �EATING SYSTEM: �' GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION l�J COMBINATION ❑ BUILDING Xj MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEH MAILADDRE55 CITV ZIP PlqNE <br />��� � z�u .��.� W. �. 9ezo 3 as3 -�y�8 <br />TEN�NT MML�DORE55 CITV ZIP PHONE <br />�RCHITECTORDESIGNER M�ILADDRE55 CITY ZIP PHONE <br />GENF.RALCONTR�CTOR MAILADDRE55 <br />PHONE STATELILENSE <br />MECNANILALCONTRACTOR MAIL�ODRE55 CIiV ]IP PNpNE ST�TELICENSE� <br />�9✓iFi.! �sr�rw/6 i7oz �AL9bxlrYr 1$�ll 98zc� 3s3 3�S/�f .�kli/�(o99b� <br />PLUMBINGCp.TR�GTOR MRILADORE55 GTY ZIP PHONE ST�TELICENSE� <br />CONTRAGT PqICE OF WORK <br />DESCRIBE W,AM AND Sq1�RE <br />PROPOSED USE OF <br />LE�AL DESCRIPTION OF PROPERTY �51qWN BELOW OR RTfRCH iW0 COPIES� <br />LOT BLOGK pF <br />P�RGELTAXI.O.NUMBEfl <br />—��-OaY• G��.Oee' <br />GONSiRUCTqN LOAN LEHDER. MDRESS, TELEPHONE NUMBER <br />L7z+s .�Ams.I 4�. <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNORV TRAY <br />CIOTHES WASHER <br />URINAL <br />FOR OFFlCE USE ONLY: <br />FRONTSETB�CM RERR; <br />USE ZONE LOT �F <br />rmr a� coxsT. ra. oF <br />SIZE OF BLOG. FIrIE SF <br />OCGUPANGVLO�U <br />P��w� _— <br />INTRKE BY <br />SUB TOTAL $ <br />PFRMIT $ <br />FIRE �URlA PEO'D <br />PIANS RPPROVED BV <br />O�TE <br />$ <br />CON'nC7pEFSOHAND"NONENO. <br />i �;EREBY CEHTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW TIiE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCE5 GOVERNING THIS TYPE OF <br />WOPK WILL BE COMPLET£D WITH WHETHEF SPECIFIED HEREIN OP <br />NOT. i�1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2'cD BY TH� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />TYPE OF EOUIPMENT <br />A/C-A/HNDLG UNITS--H.P. <br />FOPCED AIR SYSTEMS-�B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />METAL PIREPLACE ( <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PUW CNE�G/K NUMB/E-R/ - <br />y� �(L" l!/ <br />VFCRNT SITE FEE$ <br />❑ ves r_� No BUIIDING L <br />occuo.r¢r xo o!twEuix�uvne <br />cna� pLUMBING <br />BASEMENT MBCHANICAL <br />C� YES ❑ NO <br />HEIGHT IIMIiRT10N ADDITIONAL PLAN CHECK <br />OTHER <br />CITY OF EVF.RETT <br />LOCALSAIES <br />TAX CODE IS 3105 <br />STATE 9UILDING SURCl1ARGE <br />PUBUC WORKS <br />TOT�L <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />i <br />i <br />� <br />� <br />0 <br />