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�.1 <br />APPLICA7IAN FOF� CON$TRUCT aiN PERMIT everett <br />Ihe Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS f] ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />i i DEMOLITION C=i COMBINATION f i BUILDING i:i MECHANICAL i PLUMBING J�SIGN <br />OWNER FIAILADDRESS CITV ZIP PHONE <br />�ND DoL�A2 LdRQ, � 08o ESICArnoe Pl, WA�url.R£EK. CA. 9ySri6 ylS� 93S-�Sdz <br />TENANTSu �/J M^�S+(/5 V vY%T"�C'/J W/�IIN�/��•// / d� 3 PHONE / <br />�,. 0 3 y 7- a/I <br />ARCHITECi Ofl OESIGNER MAIL ��DRESS CITY 21P PHONE <br />GENERALCONTRACTOR MAILAD�RE55 GiY ZP PHONE LICENSEp <br />BFtzrL4 �ll&�ir1 I�C ��o,gexsz.69 LyNNwon,� G1A .•i�ac�6 7J6�8�35 �.R� M6'�/� �D <br />MECNANICALGONTRHCTOR MAILAD�RESS qTV ZIP PHONE LICENSEa <br />PWMOINGCONTRACTOR h1AILA0DRE5S GIiV ZIP PHONE LICENSEs <br />f _i ADDITION Ci ALTERATION <br />PPICL OF WORK �ySD,�� <br />YOi1K AND $OUAqE FOOTAGE INVOWED <br />PROPOSED USE OF <br />l0T <br />L 1 REPAIR ❑ DEMOLITION C' WOODSTOVElFRPL INSERT C BUILDING RELOCATION <br />I CONTACT PERSON AND PHONE NO. , <br />�lA'L- ('"7'"'"�`'`a. z�� <br />' PFOPERN ISHOWN BELOW OR ATiACN FOIIfl COPIES) �t <br />LeEe <br />BLOCK OF <br />OF FIXTURE OR ITEM <br />WATER CI <br />BATHTUB <br />SHOWFR <br />KITCHEN SINK 8 DISP <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />PERMIT 5 <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN RE�RSETBACK SI�ESETBALK <br />115EZONE I LOT <br />SRE OF DI.OG. <br />OGCUPANCVLOAU <br />REASON FOP SPRI. <br />INTAKE OY <br />VRCANT SITE <br />iYPEOFC@�Si.ACtUAL occuPer�tr xa.nvcmEwuGuxns <br />cxaur <br />NO.OFSTORIES BASFMENT <br />FIRESPRNKLERSREO'D HEIGHTLIlAITATION <br />a'' CITY OF EVEHETT <br />LOCALSALES <br />TAX COOE IS 3105 <br />//�'jjbSJ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIPI OR <br />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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTInN. THAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATUREOPCONTqACTOiiORAUTHORiZEDAGENT DATE <br />X �q„� �_�f'`'VC 1 -,r� 92 <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CMECK NUMBER FEE <br />-2�3 yi ✓ <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PI AN CHECK <br />OTHER <br />STATE BUII.DING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL S ' <br />HIT S <br />1L FEE S ' <br />RECEIPT NO. <br />JATION FEE <br />�� � V V <br />--� <br />i <br />� <br />i <br />i <br />i <br />i sC� <br />i <br />i <br />�y ;Sv <br />