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APPLICATI06"."' OR CONSTRUCTIZ :i PERMIT i <br />The Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS U ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 / <br />DEMOLITION COMBINATION BUILDING VMECHANICAL PLUMBING SIGN <br />OWNER A\IL ADDRESS CITY ZIP PNONE <br />T _ ae►�a.�D &Y g7o� M� of Flo .5�. WA_ 98i24•t� <br />TENAANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PP^HHO^ZN�EE <br />NE � <br />MAI SS I�OD� <br />JPPI_`—PHONE <br />• , R1GRL1014929 <br />67 7 <br />�H�[Jp�j <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE. <br />LICENSE <br />MECHANICAL CONTRAC fOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />Wssry�i� iuc <br />?Q. <br />ft 7�l � . <br />WA. <br />1812 <br />"-5TV2 <br />CIE 121 eF <br />PLUMBING CONTRACTOR <br />MAIL ADDRESSF <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />' NFW X ADDITION <br />ALTERATION <br />REPAIR DEMOLITION <br />WOODSTOVE/FRPL INSERT <br />_, 13UILDING RELOCATION <br />�7 <br />CONTRACi PRICE WOR <br />W <br />CONTACTPERSO ANDPHONENO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />40• Z3 <br />171-2 I <br />P POSED USE OF BUIL INa <br />AemL%mAPPLICATION <br />I HEREBY CFRTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Or IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED NT DATE <br />LEGAL DESCRIPT OF PROPERTY (SHOWN BELOW OR TACH FOUR COPIESI <br />LOT BLOCK OF <br />PRI ADDRESS <br />• L'tRI <br />APIPMINSCITYBUSIN SSLIC BE NO AND BUSINESS N/JAE <br />PLUMIM <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HIIDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />7 <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />' <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />7 3 D <br />PERMIT $ <br />PERMIT $ <br />S� <br />TOTAL FEE $ <br />TOTALFEE $ <br />7 - <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />^T!E <br />I <br />RECLIPT NO <br />usEzalE <br />IOi AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />' <br />TYPE OF COATS ALLOWABU <br />TYPE OF CONST ACTUAL <br />OLcUPANCv <br />GROUP <br />xO Of PWHUNG UNOS <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />I <br />i <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS RED <br />HEIGHT LIMITATION <br />OTHER <br />I <br />i <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />.PLMSAPEO By <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />E-auc woRKs <br />TOTAL <br />�i <br />