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APPLICATIQ"^' FOR CONSTRUCT;�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—ALEASE PRINT <br />�HEATING SYSTEM: �GAS C.1 EIECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLIT10�1 !� COMBINATION BUILDING �MECHANICAL j�IPLUMBING J SIGN <br />OWNEF MAILADDRESS CITY ZIP PHONE <br />f�/Gc�A (ZCC�iAt-D 5/Z G✓�'�mv/��� Ec,'7' 9a'Zo/ 2.s� `/.�'.� <br />iENANT p MAILADDRE55 CIiY ZiP PHONE <br />ARCNITECTOR��GNER MAILADORE55 CITY ZIP PHONE <br />GENEPALCONTR�CTOR MAILADU9ES5 GTY 21P PHONE STATELICENSEI <br />G Fs i'•lEA�'/NC� <br />1AECNANiG�LCONTRRCTOR MAhADDRESS CILY ZIP GNONE STATELICENSEI <br />Gss /��r-Ti�L sa� E- m���✓ nroev,eoE L�yl 9a'z�z �79-73� Gsi*�riQT.rD <br />PLUMBMG CONTPACTOR M�IL ADDRE55 GITY ZiP PHONE STATf UCENSE �_ � <br />_�_ _ -- <br />CONi �Ci(PRICENOF�WOi�( <br />�"'i10W � <br />DESGRIBE WORR �ND SOURRE iOOTAGE MVOLVED <br />�CEcTk�� �40 6A�s '�o���. <br />d�,t,. �a�: n l.ir� 2. <br />PROPOSED USE OF BUILDIN� <br />���J6LE `{�"'►` <br />LEGRI DESCBIPTION OF PROPERtt <br />LOT BIOCK — <br />PARCELT.IXIU.NUMBER <br />CONSTRUCTION LO�N IENDER. <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />UIUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF <br />SINK ( <br />OF <br />TELEPHONE <br />ATTAGH TWO COPIES� <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />FRONiSET84GK REARSETBACN <br />USE20NE IOTRREF <br />iVPEOFCONSi NDAFSTJFIES <br />S2E OF BLDG. FlFE SPAINKLERS REO'D <br />rv�ruaeurv i nnn FlqE ALARM RE00 <br />REASON <br />INTANE BV PIFNS APPROVED BV <br />CONTAG7 PEIIlQ��� N� n ONE N0. 7; Z� l�� <br />�, ��H <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE 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 OP CANCEI 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 PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITN THE STATE <br />CON ORS W 827 RCW AND 296200 WAC. <br />_ �,��5/,� � ��� <br />Np, TYPE OF EOUIPMEII7 <br />A/G—A/HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOYE <br />METAI FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTF.4N <br />NUMBER <br />VACANT SITE ��w <br />= YES �� NO gUILDING <br />OCCIIv4N[r NONUWFIL�NLW�15 <br />tnouv PLUMBING <br />BnSeMEr+T MECHANIGAL <br />I-i YES ;7 NO <br />HE�GHT uMlTntlo1+ ADDI710NAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEHETT PUBLIC WORKS <br />LOCAL SALES <br />FEE <br />$ <br />$ <br />S <br />NO <br />N <br />� <br />DATE TAX CODE IS 3105 ror�� <br />� <br />