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APPLICATIIr�I FOR CO�ISTRUC'1�,��N �P�RIIAIT �����« <br /> theEvergreen TO BE COMPLETED 1N INK—FLEASB PRINT � <br /> qTV OP _ <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � I <br /> BUILDING DEPARTMENT <br /> 259-8810 i <br /> DEMOLiTION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> ' Ol'lNER lAAiLApORESS CITV Z�P G,i�I/L��Ptl@IE f ���� � i <br /> , �'�.�_�r��1ZL�/�1/ h/1iv�- C����� �'��_`I��Q' c�U'b5b3C�,�� � <br /> �.' TEYANT MAILA�DRE55 CITY 21P PIIONE I <br /> ���m�i 50 l�l ��i��:-�G nG,� l W/�'(/�V��TT WA . <br /> ARCHREGTOROESIGNER MMLAODRE55 CITY ��P PHONE <br /> �U���T � �'�G i l�l PI N�T/�i���� ���I al Z?��I�t''IPl <br /> GENEf1ALCONTRACTOR 61AILA�D4�E55 CITY / ZIP PIIONE UCENSE <br /> ��� —�zz�r�GNTi1��J�.��x ������� .9��-�a� r �� 5�n-� <br /> IAECN�NIGALCONTPACiOR MqILADORE55 CITY ZIP PNOjy[��r�DUC/r �3�OI�WGJ� 1 <br /> � � ��.�}� <br /> ��r'L" -- " �'1 1��// <br /> C� H Pi_UTApINGLONTRAGtOfl AIAIL���RE55 CRV ZIP PNOII[ LICEHSE� <br /> a��n / <br /> CLnSSOF WOPK <br /> hyC y� '..1 NEW �.�. ADDITION �( ALTERATION . I REPAIR �. '�, DEMOLITION � WOODSTOVFJFRPL INSERT !.�. BUILDING RELOCATION � <br /> 'I CONiACT PER501!AN�PHONE tlO. ^ <br /> � H� �p /� oa ��p� r����//�/ r� <br /> y H CONTRACT PRICE OF WORK � " �/vDO� 1(y�' _K!/� <br /> I-3 r �[SCRIBEWORHAYpSOO�REi(�tAGEINVOLVED n��I �p� �N.�� <br /> � o� —�?I�_'�_ �� NI('� 17K'L�6� r �i r,c� <br /> O H� P�o�oseouseoFeui�oinc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> .� �Cy . APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT.ALL <br /> �„ � LEGRLDESCRIPTIONOPPRGYE�T�'ISNOW4BELOWOfiATT�LHFOUFCOPIES� PFiOVISIONSOFI.AWSANDOR0INANCESGOVERNINGTFIISTYPEOF <br /> C WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> z yY io� n�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOl PRESUME TO GIVE <br /> � C�i �^ " AUTHORITV TO VIOLATE OR CANCEL THE PAOVISIONS OF ANY <br /> F„�y r�rr�j��L��, OTHER STATE OR LOCAL LAW REGLILATING CONSTFUCTION OR THE <br /> �y �u PERFORA9ANCE OF CONSTRUCTION.THAT I AM�UTHORIZED BY THE <br /> O �H OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br /> �❑ d� APPLICATION IS MADE AND 1 COMPLY WITH TF{E STATE <br /> g �t+ CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �J [sJ S�GNFTUREOFLONiP/CTORORAUT40NIZEDAGENT �ATE <br /> � H fn ---- <br /> H O fn <br /> x n� - � 2� � <br /> PROJECIADDRE55 — <br /> /DI^ ��������•/ APPUCAt 5 ITYDU9NESSLICENSEIlO.AYOBU9HE551lAME <br /> P UMBING � MECHANICAL <br /> � . N0. TYPE OF FIXTURE OR ITEM FEE _� NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/CrA/HNDLG U�ITS--H.P. <br /> ���� BATHTUO FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> ���� LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> SHOWER � CLOTHES DRYERS � <br /> ' ' VENTILATION FAN <br /> I `e � KITCHEN SINK 8 DISP � RANGE HO00 <br /> a DISHWASHER <br /> � �� � WATER HEATER <br /> LAUNDRYTRAY <br /> I CLOTHES WASHER WOOD STOVE <br /> I ��� URINAL METAL FIREPLACE 8 CHIMNEY <br /> 1! DRINKING FOUNTAIN FIREPLACE INSEflT <br /> FLOOR ORAIN HEAT PUMP <br /> v � BACKFLOW PREVENTERS GAS PIPING <br /> �� � ROOF DRAINS—RAINLEA�ERS EXHAUST FA� _ <br /> SINK(SERVICE—BAR,ETC.) <br /> — �_ <br /> 4�f <br /> �� SUtl TOTAL 5 SUB TOTAL S � <br /> �I PERAl1T 5 ?ERMIT 5 <br /> TOTl�L FEE 5 TCTAL FEE 5 <br /> � FOR OFFICE USE ONLY: <br /> fRONT5E1pACK HEARSETBACK SI�ESET9�CH PLANCHECKNUAI9ER FEE RECEIPTNO <br /> USEZONE LOTqREN VACINTSitE FEES VALUATION FEE <br /> BUILDING ,��.�yy ]� ' Oe <br /> iYPEO�CdNiSAllOY:FPIF iYPEOiCGNSCAGipAI octu��t;:v bOnicnhu„u,as <br /> L01P pLUMBING <br /> SREOF�LDG. NOOFS10f11E5 BASEMENi h�ECHANIGAI. <br /> OCCUPANGVLOhD FlqESPRNNlER5RE0'0 IIEIGHiLI1dITATIOK AD�ITIONALPLANCMECH <br /> OTHER <br /> REn50N fOfi$PRINKLERS —�— <br /> STATE�UILDING SURCHAFGE y �S� <br /> iNinnenv �'���+Snrrnav[onr CITYOFEVERE7T PU3uClvo�Ks <br /> �ocn�sn�es <br /> 5 ,1� 7AX CODE IS 3105 TOTAL 7 6 �S� <br />