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m <br />�v� APPLICAT16�+1 FOR �CONSTRU�'T vN PERMIT <br />fhe Evergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />I� DEMOLITION �COMBINATION :I BUILDING MECHANICAL PLUMBING <br />OWNER MIILAOOFEuS GITY ZIP PNONE <br />Ly� � BLh`N,(� �°o d�i� aa�6 �!/e/'e J`'�— 9�a�.s 3ss- y 7 z.s" <br />TENANT MFILAD�RESS CITV 21P PHONE <br />MAIL ROORE55 �� � � <br />. ��.� . c f-- �de. <br />GENERALCONTfl/.CTOH <br />Zia rnurve <br />9���oy -3�7-d9 <br />ZIP PHONE LIC <br />MECHANICAL CONTFACTOR MNL AO�HESS QTY ZIP PMONE LICENSE � <br />PLUMBINGCONiRACTOR MAILAOORESS CITY 21P PHONE LILENSE� <br />everett <br />e <br />- SIGN ' <br />CLASS OF WOPK <br />� NEW � � ADDITION ��� ALTERATION ! ! REPAIR . _. DEMOLITION . � WOODSTOVE/FRPL INSERT �! BUILDING RELOCATION <br />TENANTIMPROVEMENTORMTERIOFREMODELONLV I CO�T�SO�ND� ; N�.� <br />CONTFACTPRICEOFWORK C" i•r//� <br />DESCRIBE WORN ANO SOUAflE FOOTAGE INVOIVED <br />USE OF BUILDING <br />LEGAL DESGFIPTION OF PROPI <br />LOT � BLOCN <br />LAVATORY <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRAIN <br />FNONTSEiBRCK <br />USE20NE <br />I�— � <br />tYPE Of LONSt. ALLUWABLE <br />REASON FOfl SPRINKLERS <br />APPL�C�TION ACG BY <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />BEIOW OR RTTACH FOIIR COPIESI PROVISIONS OF LAW ; AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRAN'ING OF A PERMIT DOES NO'f PRESUME'f0 GIVE <br />/ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />��� /��c.� px� OTHEF STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THc <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I COMPLV WITH THE STAT'c <br />CONTR C70RS LAW 1827 RCW AND 296200 WAC. <br />SiGNAT OFCONTRACTONOij(�OTHORI$E�AGENT DATE ( j�s/�� <br />L i.1GGi%G �/ <br />t/ .�/ i� <br />TOTAL FEE $ � <br />REARSEiBACK I SIOESETBACK <br />APPUCANTS <br />NO AND <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOU STOVE <br />METAL FiREPLACE 8 CHIMNEY <br />FIFEPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />��, �a.l � <br />—1 <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FE[�E S <br />�Clll� R /H LJ�AI l/ RE <br />LOTAPEA VFGANi511t �c�J <br />�+� ! , ves ' No euaoiNc � '�/ �- <br />iYCE Oi G-��Si.A IUAI. OLLuiAl:tv 1:0 OlOVIELI�NGUWiS <br />0° Z pLUMBING <br />NO.OFSTORIES BASEMENT MECHANICAL <br />Z C-: YES X NO — <br />FIFESPRNNlEF5PE0'� HE�GHTLIMITqTION �THER <br />f.l YES i I NO � <br />STATE BUILDING SURCHARGE <br />STAiE�E /� ' <br />P�nNsnaaaoveoav CITY OF EVERETT PU�UC WORKS <br />�LOCAL SALES <br />� � z TAX CUDE IS 310b TOTAL <br />�` �% /0 �G�(;� ' c7(l�l�;r�/ �J <br />i <br />� <br />� <br />� <br />L <br />