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APPLICATI�.N FOR CONSTRUC ON PERMIT <br /> tbe Evergreen everett <br /> CI7V OF • � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> � OWNER MAILADDRE55 CITY ZIP PNONE <br /> //� t- c � ,�1 ) <br /> _!-' VC✓+z. I �- �LQ..Z�- a �ltJ,)�1� �.a..l il•- �JZ N.li^� 5 Y �I/{vCvL:� I LU6.�/ <br /> � TENANT MA:LAD�PESS CITV ZIP PHONE <br /> �1�0/I/ f <br /> AflC111TECTOfiDE51GNER MAILAODRESSzZ21 C+u. CI1V IIP PHONE <br /> ; M<<u,�� � ��,.. azS��,�t��� �t�.�. ��.�II..Q '�`II- �`149 <br /> , GENERALCONTRACTOB MAILADDRESS CITV ZIP PHONE L'CENSEx <br /> � � av � Cn . I1-!- i � law �� !'_ 1�11L..�ere `i,�On� �/��-/UC� 'PI,� � .► 233P4 <br /> , MECHAMCAICONTRACTOF MAILAUORE55 CITV ZIP PHONE LICENSEa <br /> PLUMBINGCONTR0.CTOR MRILADDRE55 CITV IIP PHONE LICENSEI <br /> ( CLASSOFWORK <br /> � ❑ NEW G ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> ' TENANT IMPROVEMENT OR INTEFIOR REMODELONIY CONTACT PERSON AND PNONE NO. <br /> CONTRACTPRICEOFWORK: f � O. w �h L,� / � / S��'�� 25- <br /> „ DESCRIBE WOBK AND SOUFRE FOOTAGE INVOLVED � S UI �.i4� ��, �' , G <br /> C � CC U ' ' L. Q ` S+ur-a �.�n� C,/�- ,— 4.�-r �' �.�15'� O <br /> �: PRO!'OSC7DUSEOfFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1 L' �h/1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �; LEGALDESCRIPTIONOFPROPEflN�SHOWNBELOWORATTACHFOUflCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> ; �or BLOCK oF 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 PEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FGR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � SIGNATUREOFCONTRRCTORORAUiHORIZEDAGENT �FTE �-�'�Q <br /> C d� �\ ) <br /> �i Pfl0.1ECTADDRE55 � �) . \�a.,��- <br /> r � APFLICANTSCITYBUSINESSLICENSENO.ANDBUSINESSNAME <br /> a <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIEn � A/�A/HNDLG UNITS--H.P. � <br /> ? BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> � LAVATORY(WASH BASINj � UNIT HEATEHS—B.T.U. M � <br /> . SHOWER CLOTHES DfiYERS � <br /> � KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> , DISHWASHER � RANGE HOOD � <br /> ( LAUNDRYTRAY ; WATERHEATER � <br /> ` CLOTHES WASHER i WOODSTOVE ; <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> � DRINICING FOUNTAIN i FIREPLACE INSERT ' <br /> � <br /> FLOORDRAIN � HEATPUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � <br /> � � <br /> � � <br /> , <br /> � � <br /> � SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ; TOTAL FEE $ � <br /> FRONTSETBACK REAPSET9ACN SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> � USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> � ❑ YES � NO BUILDING . �— <br /> � TYPEOFLONST.ALLOWABLE TYPEOFCONS7.PCNAL OCcuvAx:r xo.aF EluxGurvils <br /> i <br /> . / '� ` {�auv �_ PLUMBING ' <br /> / O <br /> . SIZEOFBLDrG. O.OFSTORIES BASEMENT MECHANICAL i <br /> 4q--7 A S F �� ❑ YES 1 NO <br /> OCCUPAtNCV OAD F flE SPRNKLEflS FEO'D HEIGHT LIMITATION OTHER � <br /> /\I � YES ❑ NO � STATE BUILDING SUPCHARGE � <br /> REASONFOPSPflINNLEHS <br /> STATEENEflGVSURCHARGE i <br /> pPPLICATIONACC.BV PLANSAPPROV� CITY OF EVEflETT PUBLIC WOFlKS � <br /> LOCALSALES ' <br /> TAX COOEIS 3105 TOTAL � <br />