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APPLICATIuN FOR CONSTRUCTION PERMIT <br /> cLomll <br /> TIT Evergreen <br /> H (7 H CITY OF <br /> everett <br /> p py BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259.8810 <br /> 3DEMOLITION I I COMBINATION BUILDING i I MECHANICAL PLUMBING I I SIGN <br /> MAIL Y ZIP PHONE <br /> � <br /> 99 <br /> t< y /fpJ/ �O!9 �9aetfiuG r� ///� �O ,ais.S. aJ _p"tt /9 <br /> .rE w �s S:Ja7i�- <br /> O `.O O TENANT MA0.AD9R[SS CITY ZIP PHONE <br /> Hy 2A'I" r ;re od✓4 iree-,' 0 t? /O/ f!4/0"oW LK-I JUI17 t?1 ff90ZA' 4J/4 1 <br /> z ARCHggECT OR DESIGNER MA0.ADORE69 CITY ZIP PHONE <br /> 0 1/�R01!i /� ii6 �i/E J'vrE iot �E[lfl/uE ww�y�oolA yss'�ys'y <br /> CITY ZIP PHONE tICENSEF <br /> O H GENERALCONTRACTOR MAK ADDRESS <br /> Hag <br /> a- nC MECHANICAL CONTRACTOR MAB AL DRESS CITY ZIP PHONE LICENSE <br /> zH3 NA <br /> y PLUMB%CONtRACTDR MAIL ADDRESS City ZIP PHONE INTENSE IT <br /> y T-3 Nii <br /> H CLASS OF WORK <br /> C NNEW FJ ADDITION I l ALTERATION I I REPAIR I I DEMOLITION I I WOOD <br /> STOVE/FRPL INSERT LI BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY �../� CONT CT PERSON AN/O/'/p/1�04E N/O�.�l <br /> Oy CONTRACT PACE OF WORKt 1.A1�A� — �d ' ;A`D"-m �� <br /> DESCRIBE WONK AND SQUARE FOOTAGE INVOLVED <br /> A , u.�s- <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> gcA` �1$!lPd�OALY) Ty( APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> lE AL DESCRIPTKHI OF PROPERTY(SHOWN BEtOW OR ATT HFa'm DorlEsl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �L— —� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> toy BLOCK NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �'FA AtfA/rr/fd 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 18.27 RCW AND 298.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHDRLZED AG <br /> EN <br /> T <br /> �_DATE <br /> O X <br /> '�1 P CT ADORES --- <br /> POA P� J L� APPL bGTY BUSINESSSE LICENANO BUSINESS NAME <br /> f MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> 1-1 WATER CLOSET(TOILET) I AIC—AMNDLG 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 /> r CLOTHES DRYE ' <br /> SHOWER RS I <br /> 1 KITCHEN SINK 8 DISP ' VENTILATION FAN <br /> I <br /> DISHWASHER ' RANGE HOOD ' <br /> f ' WATER HEATER ' <br /> LAUNDRY TRAY <br /> _ CLOTHES WASHER I WOOD STOVEURINAL <br /> ___ METAL FIREPLACE 6 CHIMNEY <br /> DRINKING FOUNTAIN I FIREPLACE INSERT I <br /> .I FLOOR DRAIN _ HEAT PUMP <br /> _ BACKFLOW PREVENTERS ; GAS PIPING <br /> ' ROOF DRAINS—RAINLEADERS — ! EXHAUST FAN ' <br /> 1 <br /> SINK(SERVICE—BAR,ETC.) <br /> I � <br /> I , <br /> I <br /> I ' <br /> _I SUB TOTAL $ SUB TOTAL f ' <br /> _ — PERMIT f I PERMIT f <br /> TOTAL FEE f ' TOTAL FEE f ' <br /> CMEC ER EE RECNO A <br /> FRONT SETBACK , REAR SETBACK 810E SE K C ITw J� <br /> LJ / / <br /> USE ZONE Lot AREA VACANT SITE FEES VALUATION FEE <br /> I 1 YES 4, NO BUILDING 1 <br /> TYPE a Ca151 NIOWABLE TYPE a=T ACTUAL rcpKY[Y AO H IANHRIMett I <br /> PLUMBING ' <br /> I <br /> 52E11BLDG NO OF STORIES BASEMENT MECHANICAL ' <br /> jyv�R r/ygI I YES KNO <br /> OCCUPANCY lOAO FIRE 6PPNNLERb PEOO IK:gNT LBAIT`ATKIN <br /> OTHER <br /> N� YESNO //p 1 STATE BUIlDtN08URCIIAROE <br /> REASON FON SPRINKLERS ' <br /> STATE ENERGY SURCHARGE. ' <br /> APPUCATK:NACC.BY PIANS APPROVEOBY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br /> s -M -41 '13-4 - <br />