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— <br />APPLICATIC � FOR CONSTRUC7 JN PERMIT � <br />TO B�E COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS a ELECTRIC ❑ <br />259-8810 <br />❑ DEAApLITION I_l COMBINATION I I BUILDING � I MECHANICAL L i PLUMBING I 1 SIGN <br />OWNER ✓LCi/ MAILADOflE55 c CITY ZIP PHONE <br />TENANT <br />ARCHITECT OR DESIGNER <br />MAILADDRESS �5q_ 3 <br />ZIP PHONE <br />-� L G- Co 3�- i.J <br />ZIP �� �f PHONE <br />'(I�qg1w�I <br />GENERALCONTRACTOR � MAILADDPE55 CITV ZIP PHONE STATELICENSEI <br />OGJ ,�J E� <br />MECHANICQCONTRACTOfl rnAILADDRE55 pTY ZIP PHONE STATE�ICENSEl <br />PLUMBINGCONTMCR1fl MAIL�DORESS CIN ZIP PHONE STRTELICENSE/ <br />CLASS OF WORK <br />L7 NEW f�ION I i ALTERATION �'�. REPAtR I I DEMG',lTION I 1`NOODSTOVFJFRPLINSERT i.i BUILDINGRELOCATION <br />���/J/ ) CONITACT PE�F�SO/N AND PHONC- NO. <br />CONTMCT PRICE OF WORK `�'// � Cd v I J✓ r/ Tff� �C, Z-- i�/ �/ <br />OESCflIBE WORK AND SOUAIiE FOOTAGE INVOLVED <br />� \ <br />� G <br />� PROPOSEDUSE BUILDING <br />LEGQ DESCFIPTION OF PROPERTV �SHOWN BE�OW OR ATTACH FWR COPIES� <br />I <br />. LOT� BLOLK , OF S e0. �LJ' ✓9 % <br />PROJECTADORESS <br />NO. TYPE OF <br />WATER CLOSET i <br />BATHTUB <br />LAVATORY(WASI <br />SHOWER <br />KITCHEN SINK 8 <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DFiAIN <br />BACKFLOW PREVEI <br />ROOF DRAINS-RA <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK RERflSE19Ap' <br />Zd ' <br />USE LOTAREA <br />� - ' , <br />TVPEOFCONTS.RLLOM/RBLE TYPEOf ONSTACTIIAL <br />� � <br />SIZE OF BIDG. NO.OF STOfl� 5 <br />OC�ANCY LOAD FIRE SPRN1 ERS R� EO'0 <br />REA FOR SPRINK�EflS N/A <br />INTAKE/�� - / PLANSAPPROVEDBY <br />�L / <br />� �# 3�I� <br />� <br />FEE <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORP.ECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETH[R SPECIFIED HEREItJ OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHURITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW fiEGULATING 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 A"ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x ��' s �r/y z <br />SIGNAT E � OATE <br />NO. <br />A/C-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER a SD GOo <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />— SUBTOTAL $ <br />PERMIT $ <br />- TOTAL FEE $ � <br />f. o <br />PLANCHECNNUMBER fEE flECEIPTI:O. <br />.4 G�G o P� 6'7 7.5� 6 Pa �' z- <br />•" � BUILDING <br />OLCUW�Ntv N00� iXGONrtS <br />cnouv pLUMBING <br />BASENEN7 MECHANICAI <br />NEIGHT LIMI A�ON AODITIONAL PLAN CHECK Y <br />� SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCAL SALES <br />TAl( CODE IS 3105 TOTAL <br />f <br />