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APPLICATIO.� FOR CONSTRUCT JN PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Evergreen <br />CITV OF <br />eve rett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />i'� DEMOUTION ❑ COMBINATION ❑ BUILDING �-'� MECHANICAL 1� pLUMBING C i SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />A�r1a ��` 4`�.�.o d��` 1q �0003 �Uacc�ti+�.�,.�aa. k"u.riR 5 F 103 <br />TENANT MAIL ADORE55 � IIP PHONE <br />ARCHITECTORDESIGNER MAILAD�RE55 CITY ZIP PHONE <br />GENEBALCONTRACTOR MAILAD�RE55 CITV ZIP PHONE LICENSE� <br />MECHANICAL CONTRACTOR MAIL AOORESS CITY ZIP PHONE LICENSE I <br />PWMBINGCONTRACTOR MAILADORE55 CIN ZIP PHONE �LICENSEI <br />.�."_ _�.' ".�..�__, v�i...�._.., v��er�,. �1�i114 �1�,.'f�_ulAn Mc�re.nrT144l1� <br />�J] NEW ❑ ADDITION ❑ ALTERATION ❑ RF_pA�R ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />I CONTACT PERSON AND PHONE NO. <br />DESCflIBE WORN AND <br />'� '�e\,� 'r0 <br />PPOPOSEO lISE OF BI <br />LEGAL DESCRIPTION OF PROPf <br />LOT __ 6LOCK <br />�TAGEINVOLVED <br />Du r�a,�1 c <br />� $'T.i T/ o <br />Y (SHOWN BELOW C <br />OF <br />PROJECTADDRE55 <br />/.oa ? � vEac <br />I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TflUE AND CORRECT. ALL <br />FOUR COPIES) PROVISIONS 6F LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br />WORY. WILL BE COMPLETED WIThI WHETHER SPECIFIED HEREIN OR <br />NOT. TrIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE ON LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 6Y THE <br />OWNER OF THIS PfiOPERTY TO PEAFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUFEOf-CONTflACTORORAUTHOPIZEOAGENT DATE r/�o�f� <br />APPLIC�� BU NESS UCENSE NO. AND BUSINESS NAME <br />NO. TYPE OF FIXTURE OA ITEM FEE <br />WATER CLOSET (TOILET) � <br />BATHTUB � <br />J LAVATORY�WASH BASIN) � <br />SHOWER ' <br />KITCHEN SINK 8 DISP � <br />DISHWASHcR ' <br />LAUNDRYTRAY � <br />CLOTHES WASHER � <br />URINAL � <br />DRINKING FOUNTAIN � <br />3 FLOOR DRAIN ' <br />/ BACKFLOW PREVENTERS J� � <br />ROOF DRAINS—RAINLEADERS � <br />SINK (SERVICE—BAR, ETC.) � <br />---�— <br />� <br />� <br />i <br />SUB TOTAL $ O ; — <br />PERMIT $ � <br />FOR OFFICE USE ONLY: <br />FRONTSE7BACK REAR: <br />USE20NE <br />iYPE OF CONiS. AlLOY <br />SIZE OF BLDG. <br />OCCl1PANCY LOAO <br />flEASON FOR SPRII <br />INTAKE 0V <br />LOT AREA <br />TYPE OF CONST. ACNAL <br />NO. OF STORIES <br />FIRE SPRNKLERS flE( <br />PLANS APPROVED BY <br />SIDE SETBACK <br />NO. I TYPE OF EOUIPMENT <br />FORCEp AIR SYSTEMS—B.T.U. M E.A. ; <br />UNIT HEATERS—B.T.U. M i <br />CLOTHES DRYERS ' <br />VENTILATION FAN ' <br />T <br />RANGEHOOD � <br />WOODSTOVE <br />METAL FIREPLACE S CHIMNEY <br />HEAT PUMP ' <br />GAS PIPItJG � <br />BUILDING <br />occuvu�cr xo aoartwxcuxrts <br />LP°0P PLUMBING <br />BASEMEN7 1.qECHANICAL <br />MEIGH7 LIMITATION ADDITIONAL PLAN GHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOL'AL SALES <br />TAX CODE IS 3105 rorn� <br />TOTAL $ <br />TOTAL FEE $ � ) / ' � <br />FEE I RECEIPTNO. <br />� <br />a <br />s S� <br />