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��a� <br />O7tlx <br />9Hf~i� <br />Y <br />y N <br />!� i"7 <br />H �1 <br />�H� <br />U] H <br />Ci1 O � <br />Hl7 <br />��g <br />H <br />�N� <br />�y <br />O�t7+CA <br />Cll�. <br />�HV�i <br />HOtn <br />� � <br />APPLICATION FOR CONSTRUCTIGN PERMIT <br />Iha Evergreon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I I DEMOLITION IJ COMBINATION I I BUILDING I I MECHANICAL <br />OWNER , . %�IIA�DR1[Sr�.n � �..._ {ln ?i'lll.. 1�...�..21P � t.l� %i/ <br />� I J _.,. � r,_ �. <br />MAIL <br />ARCNIIECT OP UESIGNER <br />CI1V <br />cirv <br />zm rHor+e <br />ZIP PIIONE <br />I I PLUMBING <br />everett <br />� <br />IJ SIGN <br />CI NEW O ADDITION ❑ ALTENATION I.l FEPAIR I 1 DEMOLITION Il WOODSTOVE/FFPLINSERT U 9UILDINGHELOGAIION <br />tENANt IMPIIOVEMENT OR 11lIERIOR f1EMppEI OhLV CONTACT PE1150N AND PHONE NO. <br />CONiRRCT PRICE OF WO�K: <br />OESGRI�E WCBK ANO SOl1AqE f00iAGE RIVOLVEO <br />l0i <br />RODf1E5S <br />� PROPEPTY �SIIOWN BELOW Ofl r1TTAGH FOUR <br />OLOCK OF <br />TRAY <br />rnor+r seroncK <br />US[ IOIIF. <br />iYPC Of LONSC ALLOt4ABlE <br />51.'E OF OLDG. <br />OLCUPANCYL040 <br />f1EASON FOf1 SPRINNLERS <br />�PPLIGATION ACC. DY <br />� <br />DISP <br />SUB TO <br />PERMIT <br />TOTALF <br />nennseroncK <br />LOi �f1E� <br />tYPE OfCUN51.ACI0AL <br />NO.OF SiORIES <br />FlIIE SPPNHIERS f1E0'D <br />I_) VES ❑ No <br />PLpNS�PPROVEDBY <br />FEE <br />sioe seinnr,H <br />VAC�NT SI1F: <br />IJ YES I i NO <br />I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE : RUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES /iOVERNING THIS NPE OF <br />WORK WILL BE COMPLETEO WITH WHET'iER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTNJRITY TO VIOLATE OR CANCEL THE PROVISIONS OF AiJY <br />OTHEP STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFOflM�NCE OF CONSTFlUCTION. THAf I AM AUTHOHIZED BY'fHE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AMD I COMPLV WITH THE STA1"E <br />CONTRACTORS LAW 1827 RCW AN0296200 WAC. <br />S�GNAIUREOPCONtRACiOIiOfl<lltllOPR[��GENT DAIE <br />Xrsci�vousrt+[ssuce -r+ .n tISIN[SSNAM[ <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />CLUTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />W�TER HEATER <br />WOODSTOVE <br />METAL FIREPLACE � <br />FIREPLACEINSERT <br />HEAT PUMP <br />G�5 PIPING <br />EXNAUSTFAN <br />rinr+niecnr+umnrn � �E[ I necemrrvo. <br />BWl01NG <br />OCLUf1NCY HO OfMRLLIN! ONI15 <br />tnwr pLUM�ING <br />nnSEn�Erli MECHANICAL <br />CI YES I- I NO <br />HEIGHI�IIAITAtION OTHER <br />SiATE BUILOING SURCHARGE <br />S1ATE ENERGV SURCI IAfiGE <br />CITY OFEVERETT rueuc wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOT�� <br />u <br />