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��J �i <br />APPLICATI�:N FOF� CON�TRUCti��iON PEKMIT <br />Ihe Evergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />2�9-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWNER MAILADDRE55 CITV ZIP PHONE <br />r� �,C� � Ga3o �"��'�',��.�w�..i�� <br />TEN�NT AUILAODRESS CIN ZIP �� PHONE <br />[Fl"PLUMBING <br />everett <br />� <br />❑ SIGN <br />�n�nuc���an�en�u � nUILeuUHE55 � CITY f ZIP PHONE <br />7-�f''i'7�/�J ( cyf j'7�j(/C7%C✓% <br />GENERRLCONTflACiOR MAILADORE55 CITY ZIP PMONE LICENSEf <br />MECHANICALCONTMCTOR MAILRDDRE�S ,� HONE �IGENSEI <br />—�O.Ib/� //'�.�r-'�s�ii�i,r�ry, /�/'rJZ7 /��/� .�,�!✓/ ,��-� _ii��.� <br />❑ ADDITION <br />Z!P <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />irnwmiMrnuvr.M�rviunlnTeniONREMODELONLY , <br />LONiIUCT PflICE OF W�HNe <br />7H FOUP COPIES) <br />LOT BLOCI( OF <br />PRO,IECTAOCRESS <br />TYPE OF <br />WATER CLOS�T <br />BATHTUB <br />SINK & <br />CLO'i HES WAiHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DflAIN <br />ROOF <br />SINK 1 <br />FPONTSETBRCH <br />115E ZONE <br />iYPE OF CONST. AILOWABIE <br />SIZE OF BLD(3. <br />OCCUPAHCYLOAD <br />PE.450N FOR SPRINKLEflS <br />r1PPLICATION ACC. BV <br />ETC <br />PHONE N0. <br />I HEREBY C£RTIFY THAT I HAVE R�AD AIJD EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORD!NANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUpAE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM O:ITHORIZFD BY THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br />APPLIChTION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATUREOFCONTMCTO(iOflAUTHOpIZEDAGENT CATE <br />�(5������ G�—l/- �--�% <br />AC➢YIC TSCIiY805115�5 IB�ENO.ANDBUSINESSNAME <br />n� <br />FEE NO. TYPE OF E�UIPMENT <br />� A/GA/HNDLGUNITS—H.P. <br />i FORCEpAIRSYSTEMS—B.T.U. M E.A. <br />�— UNIT HEATERS—B.T.U. M <br />' CLOTHES DRYERS <br />i VENTILATION FAN <br />T <br />� RANGEH00� <br />�_ 'i WRTERHEATER � <br />� WOOD S?OVE <br />; METAL FIREPLACE 8 CHIMNEY <br />SUB TOTAL $ ; <br />PERMIT $ �- <br />TOTAL FEE $ ~- <br />REAflSETBACK SIOESETBRCK <br />LOTApEA VRCANTSITE <br />❑ Y[S ❑ NO <br />ttPEOiCONSi.AC1UAL oauvusr xodVxEuixGi <br />LRWV <br />NO.OFSTOPIES BASEMENT <br />❑ YES ❑ NO <br />FIflE SPflNNLEHS REO'D HEIGHTL�MITATION <br />❑ YES ❑ NO <br />PUNSAPPROVEDUY I CITYOFEVERETi <br />LOCAL SALES <br />TAX CODE IS 3105 <br />GAS PIPING <br />EXHAUST FAN <br />PIAN CNECK NIIMBER FEE <br />FEES <br />BUILDING <br />P�u�AeiNo <br />MECHANICAL <br />CTHER <br />STATE B111L01NG SUflL'HAfiGE <br />SiATEENERGYSURCHAqGE <br />PUDLIC WOHHS <br />TOTAL <br />� <br />RECEIPT NO. <br />