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APPLICATIO.� FOR CONSTRUCT�,IN PERMIT <br /> everett <br /> --'—' � fhe Evergreen . .. _ e <br /> CITv OF <br /> everett <br /> BUILDING DEPARTMENT <br /> � 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> - I I DEMOLITION I I COMBINATION I I BUILDING i I MECHANICAL �PWMBING I I SIGN } <br /> y[� � OWNEfl MAIIADDNE55 CIiY ZiP PHONE <br /> E���tl )C.. � �O 1' <br /> � TENANT MNII RDOHESS CITY 21P PHONE <br /> .$ _—_""""_."'______'_—__'__._. .__._'_ . ___" _"__—_'_"_'__ <br /> ��]](n �NCHITEC�OflDESIGNEfi b�NIMHI��l55 (%i�Y �il' PutiHE <br /> N�i� . GENER�LCGATMCTOP MAILMDPESS CItY ZIP P'�OqE LICENSEI <br /> �r�� �riCo C���'4S�/�uc�i� '� <br /> � MECHMIIC�L CONTRACT011 MAIL AOOf1ES5 ��.6�Z_ �.y� CIIY ZIP P110NE LICENSE� <br /> ���]]]o°� �'o���� C'o- �16s • - �, _N._ F-�mo„��_ 9rQo�° 77.S-73Z� S'o�� cP /93cc <br /> �� PIUMBING CONTRAGTOR IL FDDHE55 CItY 21P PHONE LILENSE I <br /> � <br /> O M C�L�A�SS F WORK <br /> .(�j� ICYNEW I.I ADDITION 1 I ALTERATION I I REPAIR I I DEMOLI1lON I I WOODSTOVE/FRPI.INSERT f I BUILDING RFLOCATION <br /> �� TEN�NTIMPflOVEM[NTONINTEflIORflF.MODELUNLY COIIIACiP[fl50NA11�P110NEN0. <br /> �H CONTMCT PRICE OF WOflN: / <br /> I �•l y DESCRIBE WOi1K AND SOURRE F00UGE INVOI.VED �� . <br /> ~ � �a /bN woP / � <br /> �� rao s ouseoFewioi � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> � IL �s f•��� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �� �Emuoes�AOPERTY�SIIOWN IICI( onnirncurouncoricsi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WIThI WHETHER SPECIfIED HEREIN OR <br /> ioi e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> � � ' OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> ._..-._—_._J PERFORMANCE OF CONSTFiUCTION.THAT I AM AUTHORIZED BY THE <br /> g _ _._ . . . AOPP ICAOTIONISSRMADET ANDPERCOMPLY WITOHKT ER STATE <br /> CONTRACTORS LAW 1827 flCW AND 296.200 WAC. <br /> SIGIIRIUPEOFCONTRNCTONOHRUTHORREDRGENT DAIE <br /> 0 ZO - e PP a - _ In� 'X <br /> PfiOJECT/�DDHE55 — - <br /> ' � APPLILA T CIT USMESSIICENSENOANOBU51NE55NAME <br /> I I PLUMBING MECHANICAL . <br /> '_' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUI ENT FEE <br /> / WATER CLOSET(TOILET� A/C—A/HNDLG UNITS—H.P. <br /> '�1 BATHTUB FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> 1_' IAVATORY(WASH BASIN) �_ UNIT HEATERS—B.LU. M � <br /> SHOWER __�_ CLOTHESDqYERS � <br /> KITCHEN SINK 8 DISP _�_ VENTILATION FAN _T_ <br /> '�I DISHWASHER _ RANGE I100D � <br /> � ' WATER HEATER � <br /> ' ' LAUNORY TRAY <br /> � CLOTHES WASHER i WOOD STOVE i <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> '� i FIREPLACE INSERT � <br /> DRINKING FOUNTAIN .----f— <br /> � FLOOfl DRAIN � NEAT PUMP ; <br /> ti�I BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN � <br /> ' ' SINK(SERVICE—BAR,ETC.) � � <br /> � i— <br /> 11 /' - -_ , <br /> —r— <br /> � _ <br /> � <br /> i <br /> f�' SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FflONTSETBACN RERNSETBAGN SIDESEIOPCK PIAHCIIECKN�MpEfl FEE flECEIPTNO. <br /> usezorve LOTAFlE� vncnr+rsire FEES VALUATION FEE <br /> I � YES I I NO BUILDING � <br /> 7YPEOfCONSiAIIOWABI[ IYPEOFLONSI.ACNRI ���v unqmvlwrvcuuus <br /> L°��� PLUM131NG i ' <br /> ---'�— <br /> SRG OF BLOG. NO.OF STOPIES BASE6IENT MECIIANICAL <br /> I I YES I I�NO — '— <br /> OCCUP�NCVLOAD FlRESPPNNlEfi5RE0'D IIEIGIITIIMIIAIION �TI�IEfl � <br /> I_I YES 1 I NO STAiE 9UILUING SURCHAHGE ' <br /> ---i-- <br /> PEASON FOfl SPflINKlEflS i <br /> STATEENEFlGYSURCHARGE � <br /> i <br /> APPIICATIONACC.BV PLANSPPf'POVE�DY CITYOFEVEflETT PUI3UCWORNS <br /> LOCALSALES � <br /> TAX CODE IS 3105 TOTAL ' <br />