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A. . <br />I - t <br />APPLICATIOiY FOR CONSTRUCTI%wN <br />PERMIT i <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />i CITYOF <br />— — <br />everett HEATING SYSTEM: U GAS U ELECTRIC <br />_ <br />BUILDING DEPARTMENT r <br />259-8610 <br />.. <br />DEMOLITION COMBINATION BUILDING MECHANICAL <br />--- <br />PLUMBING SIGN <br />i <br />OWNE�R/ MAIL ADDRESS CITY ZIP PHONE <br />/l'IspLNIN B _Lfvet€1�`��709 <br />yG(Ajq� <br />I TENANT T— MAR ADDRESS CITY 2I1 PHONE <br />I?ki-e ,.e <br />ARCHIIECT OR DESIGNER MAIL ADDRESS CITY ZIP g PHONE <br />OEyN E.RAI ONTI R//A/ACT R N ADDRESS ^ / CITY C�� ZIP PHONE ./ LICENSE q <br />MCHANICAL CONTRACTOR MMI ADDRESS CITY ZIP PHONE <br />LICENSEE <br />it <br />PLUMBING CONTRACTOR MAIL ADDRESS CIIV ZIP PHONE <br />LICENSEE <br />i CUSS Of WORA <br />KNEW I I ADDITION I I TE ATION I I EPAIR 1 I DEMOLITION I I WOODSTOVE/FRPL INSERT i I BUILDING RELOCATION <br />CONTRACT PRICE OF w(NMI <br />G�UI/11ACI PRISON AND I NONE NU <br />DESCRIBE WORM ANJD SCUAPE TF/yQJO° UGE INVOLVED <br />PROPOSE Prr n�IA D- <br />1 HEREBY CERTIFY THAT I LAVE READ AND EXAMINED THIS <br />7� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY TSHOWN BELOW ORATIACH FOURCOPIlij1 <br />J <br />�et �(A2II�J----- <br />WORK WILL BE COMPLETED WITH WHE-HER SPECIFIED HEREIN OR <br />DOES NOT PRESUME TO GIVE <br />LOT _(g& BLOCK OF <br />NOT. THE GAANTING OF A PERMIT <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />---'-" -- _ <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 />_—_-___-_-_-__----.- <br />APPLICATION I:; MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 PCW AND 296.200 WAG. <br />SIGNATUR OF G)NIRAC TOR OR AU410BIZE D AGENT DATE <br />1 l Vl-A?"C JI /l l/t, <br />------------------ <br />PiZECTADMIESS <br />� �J��JJ ` ��'l�/ <br />AFPIK.ANISCGY Pl14NFS5 I"ENI'E NC APIPD)SNE57 NAME <br />PLUMBIN3 <br />MECHANICAL_ <br />_ <br />NO. <br />TYPE OF FIXTURE ()R 171:M <br />FEE <br />WO. <br />OF EOUIPWL ENT <br />FEE <br />_ <br />WAT09 CUOSET(TOILET) <br />_ _-_ <br />- <br />_TYPE <br />AX-AHNIILGUNITS-H.P. - <br />- <br />BATH_TLB <br />__-/U <br />i0 <br />F_O_ ACED AI_E S`.'STf:MS-B. f.U. M E.A. <br />- <br />_ <br />Lf,VA7019Y IWASH BASIN) -•--- <br />- / a -' <br />H(:A1ER_S-S.CU. M <br />4UNIT <br />SHOWER i <br />_- .ILi' <br />CLOTHES ORY_ERS <br />- <br />FCFCHEN SINK 6 OISP <br />-_ i <br />VENTII ATPON CAN -_ -,-- <br />_—r- <br />_ <br />_ -�- <br />DISHWASHER -- <br />I- <br />_I- <br />-FiWl7Ef.NGl:4_OJC -_ <br />--� <br />-_ <br />LA'JND9Y'�RAV _--•__ _ <br />—�� <br />�- <br />R__HEATE H_--_- <br />- <br />CLOTHES_WA_SHE_R <br />_ <br />-- <br />URINAL _ _ -- <br />-- <br />METAL FIREPLACE & CHIMNEY <br />DRNKING FOUNTAIN <br />FIREPLACE INSERT <br />-T- <br />FLOOR DF AIIJ -_--_ -- <br />-- <br />_—_- <br />_HEAT_PL'MP _-- <br />BACKFLOV,' PRE IFNTii`iS <br />; <br />GAS PIPING <br />--�- <br />_ <br />ROOFDRA.NS-RAINLEADERS <br />_ <br />Y <br />_ <br />EXHAUST FAN -.- <br />SINK ISERVICE--BAR, ETC.) <br />_ <br />— SUB TOTAL $ <br />------- -PERMIT $ <br />t <br />�1. 's`T- <br />- SUB TOTAL 8 <br />PERMIT _S <br />- o ; <br />- - <br />_ <br />---_ TOTAL FEE S <br />L S�•' <br />---__-_-- <br />TOTAL FEE S <br />CG <br />FOR OFFICE USE ONLY: <br />FR—WS'EIR,A1 — _ REARSET SACK ''AIIESETVACK MANCHE KNUABEr� FEE PECEIPT NO <br />7 01 o rF,/ <br />uatZONE lot AREA `:A(ANTsttt --- FFEg VALUATION FEE <br />2-Z K;IDES /1 BUILDING — �Z 6 V2 Eoo <br />TYP:' GI CBNTS ALL7WARE TYPE BF 04ST ACTbkt accu ArY AI IITANDMIMKTL------- <br />�` PLUMBING <br />SRE CK BLLIG NO.OF S! 11E5 BASUIIAT MECHANICAL. <br />-Q 41 <br />5 r--- `— ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIPE SFRNFLERSPEOG HEIGH. LIMIT, ION _ - �J • ' A. �' <br />—1/� -- NC -E-B TITHER <br />REAS:)N FOR SPRNKLEIIS -- T— <br />STATEBUILDINO SURCHARGE :50 <br />INTAKE BY PANS A PI'ROVEOLN I <br />CITY W EVERETT PUBLIC WORKS 7 00 <br />j� LOCA' :TALES T� <br />TAX CODE IS 3105 TOTAL <br />