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APPLICATION FOR CONSTRUCTION t�, <br /> -. s_ :_: : �: : : <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT '1 � " '� <br /> , <br /> r� � M.AY 'cr., z �. <br /> BUILDING DEPARTMENT �HEA7ING SVSTEM: p GAS ❑ELECTRIC ❑ •.......... s <br /> 259-8810 '' � EVcR[TT...� <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O�LrU�II��F��Pt• ❑ SIGN <br /> OWNER MAIL ADDRESS CITY 21P PHONE <br /> J�tR D.CbM��I lolo:� 23�'- �R.S.� Ev��r �A ��.�-97�� <br /> TENANT MAILADDRESS CITY ZIP PHONE <br /> �ACHITECTORDESIGNER MAILADDRESS QTY ZIP PNONE ' <br /> GENERALCONT6FCiOR MAILAODR[SS CITY ZIP PHONE STATELICENSE! <br /> MECMANICALCONTRACTOR IAAILAUDRESS CITV ZIP PMONE STATEiICENSEN <br /> � PLl1MBINGCONTRACTOR MRILADDRESS CITV ZIP PHONE STATELICENSE• <br /> � CONTflACT PfilCc OF WORK <br /> � pE$CRIBE WOpK AND 60UARE FOOTAGE INVOLVED CONTACT PERSCY ANO PMONE NO. �� \ <br /> AODrnou_� �� <br /> o� I�use' Yz Ft�,n.�b 3 - <br /> j O i HERE3Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USi OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND COiiRECT.ALL � <br /> PROV!SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I IEGALOESCRIPTIONOFPROPEHTV�SHOWNBELOWORATfACHTWOCOPIES) WOP!:WILL BE COMPLETED WITH WHETHER SPECIFIEP HEREIN OR . <br /> NO7�. THE GRANTING OF A PERMIT DOF.S NOT PRESUME TO GIVE <br /> � �oT az°�K oF qUTF;ORITY TO VIOLATE OR CANCE'_ THE PROVISIONS OF ANY <br /> ` OTHER STATE OR LOCAL LAW RtGULATING CONSTRUC'.ION OR THE <br /> 1 — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PER(ORM THE WORK FOR WFICH <br /> � � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � ��PARCELTA%�LD.�NU�MBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Cpry$nUCTION�LO N LENDEF.RDD��ELEPH�MOER <br /> �zs <br /> �wW�f E D�iE <br /> r��•��$IOI (✓ � NR. WA. C YB MFSSLiC NO. <br /> � � PLUMBIN6 M CHANICAL <br /> . �'� NO. TYPE OF FlXTURE OR REM ^FEE NO. TYPE OF EOUIPMENT FEE <br /> �. WATER CLOSET(TOILE� � A/�IVHNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> ' LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M I <br /> �� SHOWER ' CLOTHES DRYERS ' <br /> � KITCHEN SINK&DISP I VENTILATION FAN 1 <br /> '� DISHWASHER � RANGE HOOU � <br /> �� LAUNDRYTRAY ; WATER HEATER ' <br /> ��� CLOTHES WASHER � WOOD STOVE � <br /> � URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> , DRINKING FOUNTAW � FIREPLACF.INSERT _ � � <br /> FLOOR DRAIN � HEAT PUh7P ' _ <br /> . � BACKFLOW PREVENTERS ; uA5 PIPING � <br /> ; ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> ; SINK(SERVICE—BAR,ETC.) I � <br /> , � <br /> ' �— <br /> � <br /> � � <br /> i, � , <br /> '� SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ �_ � <br /> � TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> � RECEIPT NO. <br /> i FRONT SETBACK REAfl SETBACK SIDE SETBACK PUN f,H�NU J ER / FEE � <br /> � � �� 4 r <br /> ' USE ZONE LOT AREA VACAN7 FIiE FEES VALUATION FEE <br /> ! ❑ YES ❑ NO BUILDING � ��� � <br /> ':"PEOFCONST. NO.OFSTORIES OCCUC0.htv HoafDWELUNGuxns i <br /> j tnouv PLUMBING i <br /> `- i <br /> � SRE OF BLDG. FIRE SPRINKLERS REO'D BASbAENT MECHANICAL � <br /> '� ❑ YES ❑ NO � <br /> � OCCUPANCY LOAD FIRE r1LARM REO'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK i <br /> � <br /> OTHER � <br /> � R�� STATE BUILOING SURCHARGE �S� <br /> i <br /> INTAKE BV PLANS APPROVEO BY CITY OF EVEHETT PUBLIC WORK$ � <br /> i <br /> LOCAL SALES , <br /> onre TAX CODE IS 3105 TOTAL � <br /> � <br />