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APPLICATION �OR CON�TRUCTIG�d PERMIT <br />fhn Evergmen <br />�IN OF <br />evereit <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />-1 DEMOLITION I I COMBINATION I I BUILDING �(MECHANICAL I I PLUMBWG <br />�WNER <br />MAIL ADDPESS ;�{' 3QG CITY ZIP P��ONE <br />�/ I �6�. 5 I'32Nc I✓tiE 11.q. ��5� %c�n �12 •�3i I <br />cirv zm P��orve <br />rer+nNr _ QS / rM(_ :E9e.55... �'�� ' - �.� C_ �. I_ .�i. onL• 9ai - -7�/7_ <br />o �Q� <br />evcrc t qN <br />05 <br />OF � fV <br />'` w�rxs <br />I I SIGN <br />CPGHITE OROESIGNER IAAIL�ODilE55 CITY � ].IP r..��.c <br />Debbi �er�ic�ar� �ogz9 Nc. 68�/�sf k�r��IqN�/,�� 9sv�3 zo� sz�- sc,�i <br />�li`I�Nn 'rE�H �� ��I �t�9 I 8R-i h tJ� A�linr ��r,r� L11a 9R7�3 �c, G�iJNE7�� DVWa rccn �s� e r.. <br />��n,T �� p110NE LICENSER <br />IAECHANICALCONTRACTOR MAILADDRE55 <br />PLUMBINGCONTMCTOR MAILAO�RE55 <br />GITY ZIP PHONE LICENSE � <br />CLAS� Of WORK <br />� NEW O ADDITION � ALTERATION ❑ REPAIR L I �EMOLITION I I WOODSTOVE/FRPL INSERT C] BUILDING RELOCIITION <br />TENANT IMPROVEMENT OR INTEIiIOR fiEh70DEl ONLY CONTACT PERSON ANO P1NONE NO. <br />CONTMCTPRICEOFWORKi(��M T��� 11�URI'*ICg yoi �o'LS S5G'I <br />DESGRI6E WORK AND SOUARE FOOTAGE INVOlVEO <br />LEOAL OESCfi1PTION OF PROPERTY (SHOWN BELOW OF �TTACN <br />LOT BLOCK OF <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCNEN SINK B DISP <br />DISHWASHER <br />IAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEPlTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) _ <br />FFiOtli SETB�CN <br />USE ZONE <br />7YPE OF CONSi. PLLOWABLE <br />SREOFOL�G. <br />OCCUPANCYlOAO <br />I7EASON FOR SPRINKLERS <br />pPPUCAT10N ACC. BY <br />REAR SET�ACK <br />l0T AREA <br />trr¢ ar ca+sr. acmni <br />! <br />�lO.OF STORIES <br />FIRE SP(iNl(lERS REO'D <br />Cl YES I.I NO <br />PLANS APPROVEO UY <br />�M r/gl�� <br />J�— I HEREBY CERTIFY THAT I FIIIVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br />coNiesl PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />' WORK WILL BE COMPLETEO WITIi WHETHER SPECIFIED HEREIN OR <br />� NOT. THE GR.4NTING Of A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFiOVI510NS OF ANY <br />OTHEP STAT[ OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITIi THE STATE <br />CONTRACTORS lAW 10.27 RCW AND 296.2 WAC. <br />SIGNATUPEOFGONiRACTOROA�UTHORIl i�IAGEN DATE <br />L �� <br />nani icn r5 crtv eU51flE55 ULENSE NO. AND USINE55 NAIAc <br />FEE <br />� <br />�r <br />$ ! <br />5 ' <br />� <br />SIDE SETO�CK <br />VACANT SITE <br />IIYE3 IINO <br />rcnnmxrr xo fll nwlll�Nf I <br />BASEIAENi <br />I I YES I I NO <br />HEIGHT LIAIITATION <br />CITY OF EVERETT <br />�ocn�sn�es <br />TAX COUE IS 3105 <br />MECHANICAL <br />in_ 7YPE OF EOUIPMENT _ FEE <br />AIR SYSTEMS—tl <br />�TERS—B.T.U. M <br />iDRYERS <br />WUOD Si�OVE <br />METAI FIREPLACE 8 <br />GAS <br />FAN <br />� SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE S <br />PLANCIIECKNUADE FEE REGEIPTHO. <br />� <br />___., vn� nennu FEE <br />BUIL�ING <br />_____—." � <br />PLUM11111NG ' <br />�� <br />— — i <br />1dECHANICAL � <br />i <br />OTHER � <br />i <br />STATE DUILDING SURGHARGE � <br />i <br />i <br />STATE E�EtiGY SUIiCtIARGE � <br />i <br />i <br />PUBLIC WO(7K5 � <br />, <br />rorn� _; <br />