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I�PPLICA7'IOn! FOR CONSTR�ICT�ON PERNAIT <br /> � CITY OF EVEf'.ETT•BUILDING DIVISION <br /> 3200 CEDAR STREET+ EVEFlETT, WA 98201 t 259-�810 <br /> ❑ DEMOUTION fl COMBINATIOM BUILDING fl MECHANIGAL f7 PLUMBING I-1 SIGN <br /> pROJECT ADDRESS ^ , � �� <br /> �L �., ;_, !:- V� <br /> py��q {1 ``MAI,L,�OOPe55 Cltt 1 �ZIP ` /� PHONE <br /> X 1 � Ip O �C�{� S uc` ���� T112,1-E1(2Y'QT� �1.1�� � W�12,1�1��� c7- ��� � �n�n5 . '. : <br /> TENANT MAIL�o0RE55 CITY TZII PHONE ' � � ' <br /> AflCHITEC�OflOESIGNER MAILAO�RE55 CITY LP PHORE <br /> , t � � '� ';.. <br /> GENEM�COM11nGTOR MnILA�OF.ESS .� QTV ZIP PNONE l`g�_��bTSE 410ENSE� '1.. ; '. <br /> MECFI',t�ICONTflamflC�M��oss`� 4'l0�\2�� - �VYPfP�'�- �l�i ��1�'_11 �oo�a 1�/L�TE`��e�a43K� <br /> pWMBHIGCONTPFf,TOR MAILADDPE55 CITY 21P PIIONE STATE4ICENSEI , <br /> GOdTH�CT PPICE OF WORK i.�. � <br /> HEATItJG SYS7EM: fl GAS fl ELECTRIC f�' <br /> DESCRIBE WORK�ND SOIIARE FOOTAGE INVOLVEO CONTA T ERSON ANO PIIONE N0. <br /> fl'�� � h�rc�f�L��r �/( t�zl� l c�3z <br /> C c� � �2� -- — <br /> � �Z _ � �( Z � / ✓�/y� � I HEREBY CERTIFY ThAT I HAVE READ ANO. EXAMINEp THIS <br /> ���� APPLICATION ANO KnOW THE SAME TO BE TR�iE AND CORREGT.ALL <br /> ' PROPOSEO USE OF BUIL�ING /� �- r . PROVISIONS OF LAWS AND ORDINANCES GO'JEPNING,THIS TYPE OF <br /> � � GLYGGA2 !l�N� � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iece�o�CHIPT10N0 peope (5lIOWNBEI on�nncHrwocoeies� . NOT, THE GRAryTING OF A PERMIT DOES NOT PRESUME�TO GIVE <br /> x tor �li a�ocK oF Q AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY <br /> �/,�B'���O,a.f�'���,J '<-ri"� / � Z 3. � � PERFORMANCE OF OONSTRU R ON TH T I AM A THORI ED BY THE <br /> �— /� y/�l' ,, � y OWN£R OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br /> ��'7 �QC , O( G0l C(V ��-�/ID"�5 �4�i APPLICATION IS MADE AND I COMPLY �JITH THE STATE <br /> PMCELTA%ID.N4MBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSiPUCTION LOAN lENOER.RODRESS,TELEPMONE NUMBER ' �.'� .� `� � �I �/ZI,�S <br /> SIGNATUPE TE <br /> ' CITY BI15ME55 LICENSE NO. <br /> pLUMBING� MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF EQl11PMENT FEE <br /> . WATERCLOSET(TOILET) � A/C—NfiNDLGUNITS—H.P. ! <br /> BATHTUB ; FORCEDAIRSYSTEMS—P.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � _ <br /> LAUNDRYTRAY ; RANGFHOO� i <br /> CLOTHES WASHER � WATER H[ATER �— <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i . METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSEflT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � <br /> GAS PIPING ' I <br /> i EXHAUSTFAN � <br /> � � <br /> i � <br /> � ' I <br /> --�- <br /> i � <br /> i <br /> SUBTOTAL $ � SUBTOTAL $ � I, <br /> PERMIT $ i PERMIT S i � <br /> —r-- <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USF ONLY: <br /> FflONTSETOACK PEMSETOALN SIOESETUnCN PIANCIIECNN IOEfl FEE flECEIP�NO. <br /> / ,;� � <br /> IISEZONE IOTACtR VALRNISIIE FEES VALUATION FEE <br /> IIYES li NO �� � "� <br /> _ aunnmr. 'J (nC� y I;t:) <br /> IIEIGIITUMIGTIOM NOOfDWELLING 512EOFOlDG/fl � <br /> ❑NI(5 PlUM61NG i . <br /> OCCUPANCY NO OfSfOWES OCCIIPANTLOFO 9nSElAENi MECIIAI�ICAL i <br /> Gf10UP <br /> flYES I'1 NO � � <br /> FIREAURMREO'D REASON PODI110NnLP1ANC11fCK � <br /> i <br /> 011lEfl i <br /> FIRESPRINKIFflREOD FEASON � <br /> STA7&OIIIlD1110 SIIRLII/lifiE ! j .`i ..� <br /> _� �. <br /> TVPEOFf,ONST PIANSPPPROVEO�Y CITYOFEVF.RETT PIIOIIf,WOlIKS � <br /> LOCAL SALES - - — - �— <br /> �,q�E TAX CODE IS 3105 7o7a� I .� <br />