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Cf APPLICATIO.. FOR CONSTRUCT( )N PERMIT eveTE I1 <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT ( HEATING SYSTEM: U GAS U ELECTRIC U 1 <br />259.8810 <br />i DEMOLITION COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br />^VMER MAIL ADDRESS CITY ZIP PHONE <br />86EIN6 H/4►N eAy Assa%fol.r�oA 4o-as Ey��edr.w�. 9�zO/ 12�-1Gl� <br />TENANT MAIL ADDRESS CITY ZIP—� PHONE <br />ARCHITECT OR DESIGNE R MAIL ADDRESS GTY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />AUS71N foHPrINY <br />/0/s-47* 4gofyfeer <br />wg. 19201 <br />266-"Oo <br />M-o1-AU•ST-Sr <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />41feb fis MffocrW <br />/6944/7X.N.F. <br />Aft AV 04 <br />Vail 8Z7-9/S4 <br />ewcoMsoNM <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />C17Y ZIP <br />PHONE <br />LICENSE <br />]ZC SEW <br />WORK <br />NEW I ADDITION I ! ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT i-; BUILDING RELOCATION <br />r-me <br />CONTRACT PRICE OF WORK .4 PRIIVkl <br />CONTACT PERSON ANU PHONE NO <br />27-96 S <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />INWOsEousEOFauI D <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS 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 AGENT DALE 19192— <br />[•fea fAe! Atw*,7?AW 30 0Z+leo I+ <br />LEGAL DESCRIPTION OF PROPERTY SH NBELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <br />PROJCCT ADDRESS <br />APPLK:ANTS CITY BUSInESS LICI:NSE NO.WD BU54ESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNOLG UNITS—H.P <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />—r— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />FIRC SPAINAMARS <br />:00 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHELK NUMBER / <br />'��3r <br />FEE <br />I <br />RECEIPT NO <br />✓ <br />/ad-nd <br />$ %lam/ <br />USE ZOIIE <br />LOTAHEA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of CONiS ALLOWABLE <br />TYPE 01 [ONST ALIWI <br />xcuvuu <br />+o anAluiY,:uMS <br />---- --- <br />----- <br />'.LU' <br />PLUMBING <br />�� <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONA LAN CHECK �/AZTJ <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHTLIMITATION <br />OTMER��� <br />/, <br />REASON FOR SPRINKLE PS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />P1�15APPROVEDBY <br />CITY O EEVERETT <br />PUBLIC WORKS <br />Y <br />LOCAL SALES <br />J <br />TAX CODE IS 3105 <br />T07AL <br />a y ; K, <br />