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`` /`_� <br />APPLICAT'��sN FOR CON�TR�JC .-d01� PERMIT everetl <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Iho Evergreen <br />CIN OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-d810 <br />❑ DEMOLITION ' I 1 COMBINATION i I BUILDING f 1 MtCHANICAL ❑ PLUMBING fl SIGN_ I <br />OWNEA AIAILAUORESS CITY 71P FHONE <br />Cifl5C�lof D6v �/�'a�r� 3� os r3a�� ���<E��' <<�J� �b�l - G%3� f` 3aD <br />TENANT M�IL�DDRE55 CIiY ZIP PHONE <br />ARCHITECTGRDESIGNER MMLADDRESS CITY ZIP PIIONE <br />GENERALCONiRACIDR MAILAO�RESS CI1Y ZIP PHONE LICENSE� <br />MECHANICALCONiR�CTOil M�ILAD�RESS CITV 21P PHO`!E LICENSEI <br />awreoin, <br />M�IL <br />^ CN7 F/�.C�/�iE p� N � lSUS w. � OSr _ <br />CU55 OF YIOf1N <br />f I NEW I.I ADDITION I I ALTERATION I I REPAIR <br />DESCBIBE WONK PNO SOURHE H <br />' I �/�77�'<t. <I) <br />� PROPOSED USE OF BUILOING <br />LEGAL UESCRIPTION OF PFOPEd <br />� LOT BLOCK _ <br />i <br />� PRQIECTAO��ESS <br />, X � �a s ���� � <br />PLUMBING <br />NO. TYPE OF <br />� / WATER CLOSET <br />. <br />oF <br />OR ITEM <br />ZIP <br />cErorE.�H <br />I I DEMOLITION I I WOODSTOVEIFRPL INSERT I 1 BUILDING RELOCATION <br />LONTALT PCRSON AND PIIONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOURCOPIES� PROVISI�NS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COtAPLETED WITH WHETHER SPECIFIED HEREIN 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 />PEflFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNEfi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />— APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC70RS LAW iB.27 RCW AND 296.200 WAC. <br />SIGN�iUREOFCONTFIACTOROAAUTHORIZEOAGENT DATE <br />� (�� l�i/ov��iWL <br />l, APPUCANIS CIN �US�NE55 UCENSE NO. AN� BUSINE55 NFME <br />KITCHEN SINK & DISP _ <br />� D�SHWASHER <br />� LAUNDRYTRAY <br />' CLOTHES WASHER <br />UFINAL <br />: DFINKING FOUNTAIN <br />FLOOR DRAIN <br />, BACKFLOW PREVENTERS <br />� RJOF DRAINS—RAINLEADERS <br />� SINI<(SEflVICE—BAR,ETC.) <br />� SUB TOTAL $ <br />� TOTAL <br />FOR OFFICE USE ONLY: <br />, FRONTSETBALK IIEARSETOACK <br />' USE ZONE L07 nRE� <br />� iYfEOFC@1f5.ALlOWABLE I 7�PEOFCONSi.RCiUAI <br />� SIZE OF BLD�. <br />OCCl1PANCY LOAD <br />REASONFOFISPPINKLERS <br />� II:TAHE BY <br />OF STORIES <br />FIRE SPRNKLERS REO'D <br />PLANS %�PPROVED BY <br />N0. <br />NC—A/HNOLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.i.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATEA HEATER <br />WOOD STO\'E <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PLAN <br />VACANf SITE FEES <br />BUILDING <br />OCCVfANCY It0 OiN1ElUNGUN115 <br />°"W° PLUMBING <br />BASEMENT �.�ECHANICAL <br />HEIGHTLIMITATION aDDITIONALPIANCFiECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EIIERETT PUBLIC WORHS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />FEE <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />..,. _ _ .. _ . . . . . . ... .. . . . . _„ ,., _ ,; �,. , . .. , ,: ,. . , <br />� <br />� <br />