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�>�: <br />APPLICATiti�l FOR CONSTRUCT��N PERMIT <br />Ihe Evorgreen everett <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �SIGN <br />OWNEfl MAILpDDPESS CITY ZIP PHONE <br />AFICHIIECTOf10E51GNEH MAILADDRE55 <br />ui$� Wy C fERG?T �/S r,e <br />CITY 21P PHONE <br />UENERALGONTRACTOI7 MAILADUAE55 CITY ZIP PHONE �ICENSE� <br />QfY ZIP <br />PLUMBIN�GONTMCWH AIAILADDRESS <br />GU55 OF WOfiK <br />�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR C� DEMOLITION <br />TENANTIMPfiOVEMENiOflINTE RnflElAO/O�ELONU ��qN <br />CONTRACTPRICEOPWOHN: ��4ypO �� <br />�ESCRIBEWORNANOSOWqEFOOTAGEINVOLVE� 9 S/l_u f�<t <br />�or <br />PflOPERTY �SHOWN BELOW OR ATTACN FOUR COPIES) <br />o�ocK oF <br />NO. I TYPE <br />I KITCHEN SINK A DISP <br />DISHWASHER <br />� LAUNDRYTRAY <br />CLOTHES WASHER <br />i - URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />I BACKFLOW PRE4ENTI <br />i FOOF DFAINS—pA1NL <br />FRONT SGTBr1CK <br />�- <br />�SE� Z <br />� <br />TYPE OF CONSC RLLOW�BLE <br />SRE OF OIOG. <br />CCCUPANCVLOAD <br />pEASON FOH SPRINNLERS <br />APPLICATION ACC. BY <br />�/lY'�-C�7' <br />SUB TOTAL $ <br />PERMIT ' $ <br />TOTALFEE $ <br />AEAfiSETBACK SIOESETBACK <br />� r <br />�i'fAREA VACANTSITE <br />�7�j.6 � o iE$ � <br />MEOFCONSi.AL7UnL a�P�' ��� <br />4PWV <br />NO.OF STORIES <br />FIHE SPRfJKLERS REO'D <br />❑ YES ❑ NO <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGIIT LIMITATION <br />PLANSAPPROVED�V CITYOFEVERETT <br />1�/ LOCAL SALES <br />N( TAX CODE IS 3105 <br />21P PNCNE <br />LICENSE � <br />❑ WOODSTOVE/FRPL INSERT ❑ BUILDING REIOCATION <br />I HEREBY CERTIFY THAT I HAVE R[AD AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING 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 VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTFIER STATB OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZ[D BY 1'HE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 18.27 RCW ANO 296200 WAC. <br />SIGNATUREQFCONiPACTORORAUTHORIZEOAGENT OAiE <br />�� <br />NO. � i'YPE OF <br />A/�A/HNDLG UNf <br />E.A. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />' SUB TO7AL $ <br />PERMIT $ <br />TOTAL FEE $ <br />PIANCNECKNUM�ER FEE RECEIPiNO. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENEflGYSURCHARGE <br />PUBI.IC WOFKS <br />TOTAI <br />d <br />p <br />i <br />