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APPLICATIO.. FOR CONSTRUCT►.�N PERMIT e°efe1 <br /> �a Erergreen TO BE COMPLETED IN INK—PLEASE PRINT � � <br /> ITY OF <br /> �verett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> tUILDING DEPARTMENT <br /> 59-6810 <br /> DEMOLITION I 1 COMBINATION I I BUILDING f7 MECHANICAL O PLUMBING ❑ SIGN <br /> WNER MAIL�U�RESS ��ry Z�p P�E <br /> Skotdal Pro�erties r n a.,,. S�ti� F o <br /> �e t t� fdA �2A�—,�5°zi��1i <br /> EN�NT MAILADDRESS ��ry Z�p PFIDNE <br /> Colbv Center <br /> RCHITECTORDE5IGNEP M�iIA�ORE55 CITY Z�p p�E <br /> ENERALLd/Tfl�GTOfl /MILADDRE55 CITY ZIP PMONE LICENSE/ <br /> Skotrial Prnnarhiac <br /> iECNANIG1lCONTA�CTO MAIL�DDRESS � CITY iIP PNONE �IGENSE/ <br /> IUMBINGCONTR�GTOR MAlLAOD S GITV IP E IC N I <br /> u55 OF W09N . <br /> . NEW I I ADDITION XX AITEFATION ❑ REPAIR I .l DEMOLITION ❑ WOODSTOVE/FRPL INSEqT ❑ BUILDING RELOCATION <br /> - CONTACT PEfl50N ANO PHONE NO. <br /> ONiRRCT PRICE OP WORN • <br /> ESLRIBE WORN ANO SOUARE FOOTAGE INVOLVEO <br /> �' r�oroseouseocem�omo I HEREBV CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br /> . APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> EG�LOESGRIPTIONOFPPOPERTY�SMOWNBELOWOPATTACMFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINOTH�STVPEOF <br /> WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � ��r e�ocK oF NOT. THE GRANTINC OF A PERMI7 DOES NOT PRESUME TO GIYE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND� I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 HCW AND 296.200 WAC. <br /> SICN�NREOFCONTMCTORORAUTHORIZEOAOENT DATE <br /> X , <br /> 11QIECiADDRE55 n� � ��� ' f,y��` `/�/�. -�� <br /> a1CANT5 CIfV OUSINESS LICENSE NO.AHD BUSINE55 NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENi FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> BA7HTU8 ; FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATEAS—B.T.U. M ' <br /> Sh�OWER � � <br /> CLOTHES DRYERS � <br /> _ KITCIfEN SINK 8 DISP VENTILATION FAN � <br /> 01;=u,yyASHER � RANGE HOOD <br /> LAUNORYTRAY ; WPTER HEATEfj � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAI METAL FIREPLACE 8 CHIMNEY , <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' ; <br /> FLOOR ORAIN � HEAT PUMP ' ' ' � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) ; , <br /> , � i <br /> -._ � <br /> _ ' � <br /> � ' <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL E ' <br /> PERMIT $ i PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE E � <br /> �OR OFFICE USE ONLY: <br /> IiONISETB�CK RURSETBACK SIDESETB�CK PLANGHECKNUMBER FEE PECEIPiNO. <br /> 1 /� <br /> SE20NE LOTAREA ' VACANTSITE FEES YALUATION FEE <br /> BUILDING � <br /> � <br /> lPEOICONiSALLOWABI[ TYPEOFCONSi.ACiWL ocCUPr,N[r MpqMrtuiN0uqrt6 <br /> caav pLUMBING � <br /> i <br /> 11EOF9LDG. NO.OFSTORIES BASEMENT MECHRNICAL � <br /> CCUPANCv IOAD FIRE SPflNKlERS flE0'0 MEIGNi UMIT�TIDN ADDITIONAL PUN CHECK � <br /> OTHER i <br /> EASON FOP SPqINNlERS � <br /> STATE BUILDING SURCHARGE � <br /> npv,E BY PL rySAPPPOVEDOv CITY OF EVEREIT PUBUC WORKS i <br /> !/ti LOCAL SALES ' <br /> % TAX CODE IS 3105 TOTAL ; <br /> _ <br />