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APP�.ICATI�N fr"OR COI�STi�IJC?.�ON PER�VIIT <br />fhe Evergreen <br />CI7Y OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMI�LETED IN INK—PLEASE PRINT <br />❑ DEMOLITION C! COMBINATION ly� BUILDING I I MECHANICAL <br />OIVNEP MAIL AD�RESS CITV ZIP PHONE <br />I ! PLUMBING <br />I TENANT � MAIL ADDRESS � CITY ZIP PHONE <br />� d,a SY a� ,F,.,.� .�n�r� �, �-�� �ea-� �s� -c�� ( <br />ARCHRECT OP DESIGNER MAIL ADDRESS CITY ZII' PHONE <br />—�:-; :;,:- <br />everett <br />� <br />❑ SIGN <br />GENEAA�ONTRACTOP MAIL ADD{iE55 CITV ZIP PHONE UGENst � <br />C7�� fd7•f�� /.i53 v�� �1 (L7A C/�'�/, ��/• �7t13/ir AG 6.�' �N �OGI.�_�:_ <br />r <br />lAEC! NICAL CONTRRCTOR MAIL AODRE55 CITY ZIP PNONE LICEN,vE � <br />�//lCQ G' <br />PUIMBINGCONTRACTOfl MAILADDRESS CITV ZIP PHONE UCEHSEN <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION �ALTERATION <br />TENAM IMPROVEMENT OR INTERIOR RoEM_O�EL ONL� <br />COMMCTPRICEOFWORK: ,�..s',/f/Jf <br />OESCfl18E WOFK ANU SOl1RNE FOOTAGE INVOLVEO <br />l0T <br />� <br />%y�_ l <br />OF PROPERTY ISHOWN BELOI <br />BLOCK OF <br />WATER CL <br />BATHTUB <br />LAVATORY <br />CLOTHES WA; <br />URINAL <br />DRINKING FOl <br />FLOOR ORAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />SINK (SERVICI <br />PRONTSETBALK <br />USEZONE <br />TVPE,OF CONSL AILOWABIE <br />FIXTUFiE OR ITEM <br />f I REPAIR I I DEMOLITiON I I WOODSTOVEIFRPL INSERT C I BUILDING RELOCA'fION <br />PEflSON AND PIIONE NO. <br />�� <br />I HEREBY CERTIFY THAT' I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THF SAME TO BE TRUE ANO CORRECT. ALL <br />FOURCOPIES� PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TVPE OF <br />WORK WILL DE COMPLETED \VITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT�NG OF A?ERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATF OR CANCEL THE PROVISIONS OF ANY <br />OTHER STP.TE OR LOCP.L LAW REGUL�TING CONSTRUCTION OR 1'HE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW�IER OF �iHIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />__ APPLICATION IS MADE AND I COMPLY WI i H THE STATE <br />CONTRACTORS LAY! 18.27 RCW AND 296200 WAC. <br />SIGNATIIREOFGONTRAGTORORAUTHOflIZEDAGENT DATE <br />,� x �-���;%�� <br />c���� � � ., d �, crKsrw�y,.,, ;�: <br />APPLICANTS ITY 611SINE55 LICENSE AND BUSINESS NAME <br />MECHANICAL <br />TYPE OP E�UIPM <br />IDLG UNITS—H.P. <br />i BASIN) � UNIT HEl.TERS—B.T.U. M <br />CLOTHES DRYERS <br />DISP � VENTILATION FAN <br />RANGEHOOD <br />! WATER HEATER <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />REARSEiBACN I SIOESETBAGN <br />l7T AREA <br />NPF Oi CONSi ACTUAL <br />SIZE OF BLW. NO OF STifl1E5 <br />/%33 T.�� <br />OCCUPANCY LORD FIRE SPRNKLEPS REO'D <br />SZ f�QES Il NO <br />flEASON FOR SPRINKLERS <br />VACANT SITE <br />f� YES i 1 NO <br />acuvexcr xoo�nwauxe� <br />BRSEMENT <br />❑ YES II <br />MEIGHT UMITATION <br />APPUCATI� BV PUNSRPPROVEDBV CITY OF EVERETT <br />LOCAL SALES <br />�� TAX CODE IS 3105 <br />CHIMNEY <br />IY�lul� <br />Fi�^! <br />` FEE 7, <br />� � (.-J <br />BUILDING <br />�LUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUFCHARGE <br />STA7EENERGVSURCHARGE <br />PU9LIC WORKS <br />TO1'AL <br />M E.A. <br />� <br />- , - <br />T <br />1 <br />I <br />)TAL $ <br />� <br />r :� � <br />FEE $ �_ <br />�;-> RECEIPTNO. <br />/ �.3 � <br />TION FEE <br />i <br />i � <br />i <br />i � <br />