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APPLICQTiI;�! �'OR GONSTRUCI`rON P�RMIT <br />Or� Evergreon <br />CITY OF <br />everett <br />BUILDIN(a DEPARTMENT <br />259-8810 TO BE CONPLETED IN INK—PLEASE PRI�VT <br />� DEMOLITION ❑ COMBiNAT10N ❑ BUILDING '64 MECHANICAL O PLUMBI�G <br />OYMER MAILADOOE55 CITV ZIP PMONE <br />��wu,.�l li, QG�IC /a03� �HJ�PrH�✓F��1/Pve'('I' WP. �Pr7�3 355-3D47 <br />TENPNT IA�ILA�DIlESS CITY ZIP PMONE <br />AFCMITECTC:OESIGNEF M�IIAUDRESS CITV 21P PHONE , <br />GENEMLCONTPROTOfl MAILAOUBESS CITY ZIP PMOt1E LICENSE� <br />everett <br />� <br />7 SIGN <br />MECNMIICALCONTRACTOfl MAILAUOflESS CITY ZIP PHONE LICENSEI <br />'� GE5�r5oN �'pN5'( /NC, clOU-t<G�'�i•S�IJ��l�S �-yNtr�iaa�l� (✓F. �iPD3G �7P-SS�G - �E57'�C�c'zbYN�° <br />PWIABINGCONTflACTOfl MAILRDDOESS � GITY 11P PHONE LICENSE� <br />❑ NEW ❑ AD�ITION ❑ ALTERATIOM 0 REPAIR ❑ DEMOLITION I 7 WOODSTOVEIFFlPL INSERT ❑ BUILUING RELOCATION <br />'EN/JITIMPROVEMENTOflINTEfl�IOpR�REM0�0E�t�b'LV �`j pl <br />CONTHACTPRICEOFWORN: T�ifrj �� <br />DESLRIBEWOF.NAN'ISOUAREFOOTAG INVOWED <br />; �UCT�� 4 <br />PqJPO5E0 USE OF BUILDING <br />/V10'�-C � � <br />LEGAL �ESCflIPTION OF PROPERiV (SHOWN BELO'R Pi� ATTRCH FOUfl COPIES) <br />�oT o�.ocK oF <br />I�RESS <br />3U —�ve.-r v�ee h GJ a <br />BING <br />TYPE OF FIXTURE OR ITE' <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP_ _ <br />DISHWASHER <br />LAUNDfiY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLCOR DRAIN <br />BACKFLOW PREVENTERS <br />POOF DRAINS—RAINLEADERS <br />SUBTOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />FRONTSETBACN NEAfl£ETBACK � SIDESETOACK <br />USEZONE I LOTAREA <br />lYPEOFCOHST.PIlOWABIE I TYPEOFLONSTACTIIAI <br />SREOFBLIX3, � NO.OFSTORIES <br />OCGUPANCYLOAO <br />PEASON FOR SPf11NKLERS <br />FIRE SPRNNIEPS fiEO'D <br />❑ YES ❑ NO <br />pPPLIGRTIONRCC.OV I P�NSAPPROVEDBY <br />CONTACT PERSON AND PMONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ P.ND EXAM6VED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPeCIFIED HEflEiN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRCSUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUGTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O�IJNEFl OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br />APPLICATION IS MADE AND I COMPLY WITIi THE ST�TE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUflEGFCONTRACTOROflAUTHOf11ZE0AGENT DAiE <br />FEE I NO. <br />AND BUSINE55 NAME <br />MENT FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATER <br />4JOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />TOTAL $ <br />NIT S <br />PLMlCHECNNUMOER I FEE � flECEIPTNO. <br />vaCnNrSiTE FEES <br />❑ YES ❑ NO BUILDI�G . <br />p[CI1pANCY 1q.piRN[IIMGIIN�15 -- <br />°flDOv pLUMBING <br />DASEMEN7 MECHANICAL <br />�.YES ❑ NO <br />IIEIGHTLIMITATION OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSUflCHARGE <br />CITY OF EVEflETI' Puauc woRKs <br />LOCAL SALES <br />TAX CO�f IS 3105 TOTA� <br />H <br />