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J <br />APPLICATI�N FOR CONSTRUCT�N PERMIT � <br />TO BE COiHF'LETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT � hFA71N.ra SYSTF.M: 0 GAS ,�ELECTRIC ❑ � <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL p PLUMBING ❑ SIGN <br />OWNEfl MAILADUqESS <br />��v ����eT�� ��3�-sz � sT s ru t��,� r��s'ao 3�-,� �N�� <br />� � s6 dqqZ. � <br />TENMIT� MAILAD�flE55 CITV ZIP � owwc �� <br />APCH <br />MAIL AODflESS <br />��� <br />MAIL ADDflE55 <br />CITY <br />ZIP <br />ZIP ' PMONE � ST�TE <br />mECHnrvICALCONTMCTOq MAILAUDflESS CITV ZIP PXONE STA?ELICENSEt <br />FIUMBINGCONTMCTOR MAI�ADDflESS CITV 21P PHONE gTAfELICENSEI <br />OF WORK <br />lCi .�6 <br />, lST L� <br />Df BUILDIN(3 <br />�cuK �e�;mr i iun ur rryppERTY (SMOWN BELOW Ofl ATTACH TWO COPIES) <br />iorS /V.2 e�ocK-�— oF �LFT GF E�E,Hi <br />•. • _ <br />.�. ���. �.cii�s�i� <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWAS4ER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />! FLOOR DRAIN <br />� BACKFLOW PREVEP <br />ROOF DRAINS—RAII <br />� SINK (SERVICE—BAi <br />i <br />FOR OFFICE USE ONLY: <br />FflOMSETBRCK p�q; <br />� �. <br />USEZONE LOTAF <br />r <br />1YPEOFC�ONST. NO.OF <br />1 / A: <br />� <br />L'I�F: : <br />INTAKE BV <br />��' <br />��l <br />� <br />�i/ <br />' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFCT. ALL <br />PROVISIONu OF LAWS AND ORDINANCES GG:'cRNINu THIS TYPE OF <br />WORK WILL BE COMPLETED WIT4 WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI\'E <br />—� AUTHORITY TO VIOLATE OR CANCEL THF PROVISIONS OF ANY <br />� OTHER STATE OR LOCAL LAW REGULATING CUNSTRUCTION OR THE <br />PERFOFMANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />� OWNER CF THIS PROPERTY TO PERFORM THE WOqK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x�� �62��. 3 /�--r/ � <br />_ ax3�rtUHE O�iE <br />NO. TYPE OF EOU�PMEN7 FEE <br />A/C—AIHNDLG UNITS--H.P. <br />� FORCED AIR SYSTEMS—B,T.U. M E.�— <br />, <br />VENTILATION FAN <br />RANGEHOOD ,� <br />WATERHEATER ,�� <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN J. <br />� <br />SUB TOTAL $ ; � SUB TOTAL <br />PERMIT $ � PERMIT <br />TOTAL FEE $ ' TOTAL FEE <br />, yo� S'7 3�s. ;5 <br />�WtlOi _ /��E/.5 L'I�t PLANCHE�^�.iOC FE�/• �2 <br />l.0 �J <br />❑ YES ❑ NO BUILDING � <br />occun�xcr rro.o�uxnuxcuxns <br />G�P 'L PLUMBING <br />R-s <br />FIRE £^PMKLERS REO'D BASEMENT _ � MECHANICAL - <br />/✓ t ❑ YES L9'NO <br />FIREALAflMREO'0 HEIGHTLW��non ADDITIONALPLANCHECK <br />ilwolcF 7[ rC�K'�t S 0 <br />OTHER <br />STATE BUILDIN� SURCHARGE <br />P�.AN5 PPROVED BV CITY OF EVEFIETT PUBLIC WORKS <br />�� Mt LOCAL SALES <br />DFTE 6-1' - g i TAX CODE IS 3105 TOTAL <br />i <br />/�Q ' 00 <br />� <br />n./ :r� <br />