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' <br />� <br />APPL,ICATIQ"'; FOR CONS'iRUCT"9N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />IHEAT -- <br />BUILDING DEPARTMENT ING SYSTEM. J GAS �J ELECiRIC U_ � <br />259-8810 <br />I I DEMOLITION I I COMBINATION I i BUILU" ; MECHANICAL I! PLUMBING I i SIGN <br />OYMER MRIL �DD�ESS CITY )iP PHpNE <br />�IQ�c�i C�r:s1�.,m Nr�rne' \1311-\35''�' A've N� �zS�c �t�10 �����r�lle , Wg 9�?z <br />TEN�NL MAiI �DDfi[SS CITv ZiP VNONf <br />zob -VB 1-8 � 3 3 <br />��iCr�rtECfOpDE51GN[P M.11La�ORE55 CITY 2iP I'NONE <br />GEIIEARIGONiqACiOR M�II.�DDRESS CIiV ZIP PNpHE STATELIGENSE� <br />Y�G�C�R� C�t��TY1 �iZ;`c'(1 e S SCLrcT1 e_ <br />MECNANIC�ICONiIUGTOP M�I�pDDriE55 CI1Y <br />m���a�-� m��ccl _ <br />PLUMBINGCONTR�CTOP M61LApDRES$ CiTv <br />Q �k��s ? Sen <br />CONiRRGT PRICE OF WORK <br />DES':PIBE WORK �N� SW �RE FOOT�OE INVOLVEO <br />PROf'OSEO USE OF <br />LOT� BIOCN <br />P.IRCEL TA%1 D NUMBER <br />GONSTRUCTIONLO�NLENDER. <br />WATER <br />Z LAVATORY ( Wl�SFI BA; <br />SHOWER <br />� KITCHEN SINK 8 DISP <br />� DISHWASHER <br />— U�UNDRY TRAY <br />CLOTHES WASHER <br />— URINAL <br />— DRINKING FOUNiAIN <br />� FLOOR DRAIN <br />� BACKFLOW PREVENTI <br />— ROOF DRAIN�RAINL <br />.� CINK (CFt]VICF_pSG <br />r�rvc STALE IICENSE • <br />PNONE S7AIE LILENSE • <br />CONT�CT PFRS(NI AND PMONE NO <br />. i HEREBY CERTIFY THAT I HAVE qEAD AND E%AMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />��\c�?,u1C�J PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />BEI�WOR�iTRCHTWOCO�I SI WORK WILL BE COMP�ETED WITH WHETHEF SPECIFIED HEREIN OR <br />— oF �ID�'� p S�'IO NOT. THE GRANTING OF A PERMIT DOES NOT PRESI:ME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PAOVISIONS OF ANV <br />OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFiS LAW 18.27 RCW AND 296.200 WAC. <br />.EPBOHE NOMBER <br />� � � � „� � io la3 _ <br />FEE NO. TYPE OF EOUIPMENT <br />A�C—AHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.t.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />� VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER <br />�— WOOD STOVE <br />' METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />' HEAT PUMP <br />Z GAS PIP;4G <br />�_ EXHAU51-FAN <br />i <br />T <br />-�— — — <br />SUB TOTAL $ �_ <br />PERMIT $ � � — <br />TOTAL FEE $ � � <br />FOR OFFICE USE ONLY: <br />FRONiSETBALY, qEAR SETB�CN <br />USE IONE lOT �REA <br />iYVE Of COH51. � � Si0RIE5 <br />SV.E OF B100 FIRE SPRINALERS REO'D <br />OCCUPANCY 10�D FIRE �URM REO9 <br />INTANEBY I PlFN54PPPOV(DOv <br />o�re <br />SIpES[i9ACN PUNC��ECKIWMpEH <br />y�Ua�� <br />V�L�Ni SIiE FEES <br />' �I VES ! ' NO BUIIDING <br />an�wwar xonm�nuxr,ux�u - -- <br />cwwo <br />PLUMBING <br />B�SEMEN7 MECHANICAL <br />i� �l VES ' ' NO <br />NEIOHTUMIiATION ADDITIONALPIANCHECN <br />OTHLR <br />STRTE BUILOING SURCHARG[ <br />CITY OF EVEHETT ruouc wonres <br />LOCALSALES <br />TAX CODE IS 3165 roTa� <br />FEE <br />—T- <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />fEE PECEIPiNO <br />VALUATION FEE <br />— — _ _ i <br />— � <br />3; ao <br />-- T <br />i <br />0 <br />