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APPLICATIa_ i FOR CONSTRUCT' )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM:�GAS G ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION iJ BUILDING C I MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILA�DRESS CITV ZIP PHONE <br />//hAh'f/hA Dl�CFJW 4"7/7 J'� 4dE S�aTv FY 1�Lo1 P oS.i -/L� <br />TENANT MAIL ADDRESS <br />�'� GITV 2iP PHONE <br />ARCHITECT OR OESIGNEfl MAIL ADDRESS <br />GENEPAIGONTRACTOR MAllA0DRE55 CITY ZIP PMONE STpTEI�CENSE� <br />MELHANIGAL Wr1TRACTOR MAIL R�DRESS CITY ZIP PHONE STATE LIGEkSE • <br />lfJE�'1/ltk�3i •"t+c�i ",i-�� "''///i/.:rE: FY �rs'1 -'� Jsz-3//�� EYr�'/�t�zdT7 <br />PLUMBINGCONTflALTOR MAILAOORESS <br />CIiV ZIP PNONE SiATELICENSE• <br />GONI RACT PRICE OF WORN <br />5�5I/ �'y <br />OESCNIBE WORK AND SOUARE FOOTAGE INVON@D <br />PROPOSED USE OF BUILDING <br />1�2t,�/ <br />LEGAI DESCRIPTION OF PflOPERTY �SHOWN BELOW OR ATTACM TWO COPIE 5) <br />l0T BLOCN nF <br />PARCELTA%I.D.NUMBER <br />CONSTRUCTION LOAN IENDER. A9DRES5. 7ELEPHONE NUMBER <br />pROJECT ADORESS <br />s�i� ��A�� s�. <br />PLUMBING <br />NO. TYPE OF FIXTURE OR �TEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIPI) _ <br />SHOWER — <br />KITCHEN SINK 8 DISP <br />UISHWASHER <br />LAUNDRYTRAY <br />CL�THES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROGF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) _ <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />conurccraACK REARSETBALN <br />USE 20NE <br />iVPE OF LOHSi <br />91ZE O� 6LOG. <br />OCCUPANCVIO�D <br />PEASON <br />INTpNE OY <br />LOT AREA <br />NO.OF SiOP:ES <br />FIRE SPqINNLERS REO'D <br />FIR[ �LAPM REO-D <br />PLANSAPPPOVEDBV <br />Dn7E <br />SI�E SETBl�CK <br />CONTACT PERSON AND PHONE NO. <br />� LSL— <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE 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 OR CANCEL 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 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br />x �� �/'.� %//s/�'3? <br />SGrvniunF o�tE <br />Ci1V POS�NES<ULENSE 60 <br />FORCED AIR SYSTEMS—�.T.U. ��M E.A. ' <br />UNIT HEATERS—B.T.U. M � <br />CLOTHES DRYERS <br />� <br />VENTILATION FAN ._ _� <br />RANGEHOOD <br />WATER HEATER � <br />WOOD STOVc ' <br />. .__" _ _ '. .� .......... �.i �n�unir i <br />FIREPLACE INSERT � <br />HEAT PUMP _ ' <br />` � <br />; GAS PIPING i <br />� . EXHAUSTFAN _,' <br />❑ YES G NO <br />acwaacr r.aorvxEwxcua�is <br />cepuv <br />BASEh1ENT <br />^ VES C NO <br />CITY OF EVEHETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />BUILOItJG <br />PU161BWG <br />N:°CHANICAL <br />ADDITIONAL PLAN CHEG� <br />OTHER <br />STATE BU!L�ING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />SUBTOTAL <br />3 <br />5 <br />� <br />