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� <br />APPLICATIO� FOR CONSTRUCTI�N PERMIT everett <br />� e, rne Everpreen TO BE COMPLETED IN INK—PLEASE PRINT <br />�� cin oF <br />; everett HEATING SYSTEM: GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8870 <br />.1 <br />❑ DEMOLITION ❑ COMBINATION <br />MAIL AD�RESS <br />; .��-� �an��.�,-�� � <br />TENANT MRILADDRESS <br />, <br />BUILDING <br />cirv <br />❑ MECHANICAL <br />zi� <br />21P � <br />❑ PLUMBING f.� SIGN <br />«' �5��.��� <br />9�'�' ' <br />'p 5�/7_/��3� <br />j ARCHITECTORDESIGNER MAILADORESS CITY 21P PMONE <br />� <br />i <br />� GENERAL CONTRACTOR MAIL ADDRESS CITV 21P PHONE UCENSE � <br />i � �li .Qi�t►�oG✓ <br />� MECHANICALCONTR�CTOR MMLADDRE55 CITY ZIP PHONE LICENSEM <br />1 <br />�. PLUMBINOCONTRACTOF MAILADDRESS CITV ZIP PHONE UCENSE� <br />�1AS50F WONK <br />� ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BU�LDING RELOCATION <br />� CANTACTPE �S9Gf��P�/ANO / OO � . J7' /'/��— <br />' __._____""____...__.. f.lF.11�FY1ti � /!/ <br />} �/in�G� � �� ?�/D � <br />F raoroseo use oF euaoiNc <br />r <br />� I !O �Kl �( � lEYc t�lina <br />LEGM. DESCRIPTION OF PROPERTV (S�iO /N BELOW OR ATTaCH <br />d wr _ e�ocK oF <br />'� PROJEC7ADORESS <br />' g/�-� �v�2� <br />� PLUMBINO <br />i N0. TVPE OF flXTURE OR <br />WATER CLOSET (TOILE� <br />� 9ATHTUB <br />( LAVATORY(WASH BASIN) <br />� SHOWER <br />� KITCHEN SINK & UISP <br />� DISHWASHER <br />� LAUNDRYTRAY <br />� CLOTHES WASHER <br />UHINAL <br />� DRINKING FOUNTAIN <br />FLOOR DRAIN <br />G BACKFLOW PREVENTERS <br />' ROOF DRAIN�F;AINLEADER <br />' SINK (SERVICE—BAR, ETCJ <br />`� ~ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FWR CAPIES) PROVISIONS OF LAWS AND Cp�INANCES GOVERNING THIS TYPE OF <br />WOHK WILL BE COMPLETED W�iH 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 UW REQUUITIN6 CONSTRUCTION OR THE <br />PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOfiK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATUREOFCONTRACTOPORAUTHORIZEDA6EM DATE <br />x ; G-w-a l <br />L �PPLICINTS CITY BU51 LICENSE NO. AND BUSINESS NMIE <br />.. � SUBTOTAL $ <br />PERMIT $ <br />� TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETHACK SIDE <br />TVPE 0F <br />IE �OTAflEA <br />ONTS.RLLOWABLE TYPEOfCONSi.ACTUpL <br />BLOG. NO.OFSTORIES <br />�,( 5 r[� . <br />NCV LOA� F�RE SPRNKLERS REO'D <br />No <br />I FOR SPRINNLERS <br />INTAKEBY PLANS PROVEDBY <br />- //�I <br />t <br />VRCANT SITE <br />FEE NO. PlPE OF EWIPI <br />T A/�A/HNDLG UNIT�H.P <br />� <br />; FORCED AIR S`.'STEMS--B <br />� UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOODSTOVE <br />� METAL FIREPLACE 8 CHIM <br />; FIREPLACE INSERT <br />�— HEATPUMP <br />; GAS PIPING <br />� EXHAUST FAN <br />PUNCH KNUMBEfl <br />9� %ai,7 <br />euaoiNc <br />OQU>INCY NO.OfVMLIINGOHIiS <br />AWP PLUMBING <br />Bn5E1AEN7 MECHANICAL <br />HEIGHT LIMITATION AUDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEflETT Pl1BL C WORKS <br />LOCAL SALES <br />TAl( CODE IS 3105 �TAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />SO.o00 <br />� <br />� <br />� <br />C7' <br />p <br />