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APPLICATIOI. FOR CONSTRUCTkoN PERMIT i <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: GAS U ELECI RIC J <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL AOLRESS CA CITY ZIP PHONE <br />TOE: G0�(N6 co Po• 00)( 3'707 M4Or-7G S!�yr ,5 Wp• 3qZ—&V' F <br />TENANT MAIL ADDRESS i CITY ZIP PHONE <br />SA-rtnc A+-S r,WNSn— <br />FICHITECTORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br />-r'fE ,4�srEN ram. <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Tµa; fWSTIA Cd. 112y_" A-VE. W, EVTrtc77T, 6vA-. ?90'-9/7z AUSrlC7377N3 <br />MECHANICAL CONTRACTOR MA ADDRESS CITY DP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS OF WORK <br />,_/NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVErFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK I � O-2SLo /� TO <br />CONTACT PERSON AND 140NE NO <br />--EON Nn J /�S %(��I'R7AjO/Y•SC � 2c <- 3.r6 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />fj'7/z�zF-SFr A'S SE+✓L 3C- <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 296.290 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE OO <br />X /, 4 A/G <br />APPLICANTS CITY ASIN SLICENSE NO AND BUSINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OG ATTACH FOUR COPIES( <br />LOT BLOCK of <br />— <br />PROJECT ADDRESS n <br />-1 In7, C/}SZNP 2Z� p r. O,� /r <br />t' 6 J <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—AJHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 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 />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />h�Q <br />REM SETBACK <br />SIDE. SEi AC <br />rt �C <br />"� sK PLAN CHECK NUMBER <br />35o 44 <br />FEE <br />e� wee <br />RECEIPT NO <br />USE 20N <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />-Z- <br />n <br />Aa <br />BUILDING <br />j; <br />/ <br />IVPf 0E W� S ALLOW/ABLE <br />// A/ <br />JL <br />TYPE OF LOIISI A IIIAI <br />_ <br />IXLUPAMr <br />Gam°, <br />xo a vnuuNt WPS <br />'�� <br />PLUMBING <br />_- <br />�- <br />o <br />SIZE OF�BLDG NO OF STORIES BASEMENT <br />(00 <br />OCCUPAN LOAD FIRE HEIGHT LIMITATION <br />MECHANICAL <br />ABBR19NAt PLAN CHECK <br />!— <br />/PRNKLERSREOD <br />LT f T H2O / <br />OTHER <br />; <br />NEASOH FOR PRINKLERS <br />Q0(3 <br />STATE BUILDING SURCHARGE <br />T <br />So <br />INTAKE BY <br />PLA 1 APPROVED BY <br />`� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />31, o e 3 <br />V <br />