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APPLICATIdrI FOR G;ONSTRUCT dN PERMIT <br />everett <br />Ihe Evergreen n \ � <br />everett �'L <br />BUILDING DEPARTMENT -7 BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />i i DEMOLITION x COMBINATION BUILDING MECHANICAL PLUMBING J SIGN <br />IOWNEF D MNLADDRE55 �^ CITY GZIP PHONE <br />Fi�f'�. �.O�/✓��, ueu��FCSOi�i�fVi% G(�E[h=� <�ad_3 PZN�YP 3.5'S-Y72.� <br />ARCHITECTORDESIGNER MAIL�DORE55 CItY ZIP PMOrve <br />/�.e-oioFsi . /a��� �r` f"v�erof¢- 9�ao� 3�f7-o y�f� <br />GENERALCO� MNILADDRESS CITY 21P PHONE LIGENSEM <br />L�er Bi/�� ��• ,5�.� �dhd rr'vaa�� aas .�S'S-y7z.f ,d_��'ikBP�t�� <br />MEGNANCA'.CONTRACtOR MAILADORESS CITY 21P PNONE LICENSE� <br />PIUMBIPiGCONTRACiOfl MAILADORE55 CITY 21P PNONE 4CENSE• <br />�G SSCFWORK <br />NEW ��� �4DDITION ❑ ALTERATION :._ REPAIF �. ' DEMOLITION �. .: WOODSTOVE/FFiPL INSERT G BUILDING RELOCATION <br />TEHA4T IMPFOVEMEfJT OR INTERIOR REMO[1EL ONLY I GONTACT P[RSON AN� PHONE �Nj0.��1� / _ <br />CONTRACTPRICEOf WORN �YL� E p`y�/vI� <br />OESCflIBE WORK RNL SOUARE FOOTAGE INVOLVED _ _ , � __ <br />r'� <br />LEGFL DESGRIPtIOP OF PROPERtt �SnOwrv new� <br />LOT _�_ BLOCK � OF <br />T <br />�i3s �"J'i�'�.sA'z'/S%F� � <br />T.%SCr��`iv.J cv�! <br />PGOy' /��,,� � <br />5'7/��P �ma ��,C3 <br />PROJ OTA�DflE55 � � <br />I�L•F971�� <br />ROOF <br />FPONTSET�ACK <br />1.r> <br />USE20NE7 <br />P'!� <br />iYPE OfWN51.A110'NA6lE <br />��� <br />s¢�3i8G Sf fi <br />Svo SP Ga,C <br />OGCIIPANCYLOAO <br />_ �.1 �A <br />REASONFOR SPRiNKLEflS <br />APPLICFTION ACC. OY <br />RERRSETBFCK <br />� <br />lOT AREA <br />I HEFiEBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO ?ERFORM THE WORK FOR WHICH <br />j�PPLICATION IS MADE AND I COMPLV WITH THE STATE <br />QpNTRACTORS LAW 18.27 RCW AND 296.200 WAC. � j�p� <br />LIGNFTU� NTRA� NJ�R AU HO�PyENT QA/ G'�/ 7��� . <br />� P%� / /✓' l% <br />/ �� <br />X ,i � R/%,../� <br />FEE S <br />I SIOESET�pCK P�/H <br />9ifS CITV B115W[55 LICENSE NO. ANp B <br />ANICAL <br />TYPE OF E�UIPMENI <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />ERHAUSTFAN � <br />� : `. YES - N� BUILDING <br />TYPE�� ONSLACNAL C�LOipNtv NpOfPAFILINGON:15 - <br />�P�_� � PLUMBING <br />NO.OFGTORIES BASEMENT MECHANICPL <br />2 �. �. VES X NO <br />FIRESPRNKLEPSREO'0 NEIGHTLP}ITATION OTHER_ <br />l�i YES f. ! NO _ STATE BUILDING SURCMARGE <br />-&7hSE-ENEfl6K6NR6VdAR6E <br />PlANS APPROVE� BY CITY OF EVERETT PUuUC WORK$ <br />LOCAL SALES <br />��l ,. /, o/e -, TAX COUE IS 3105 TOTAL <br />/!U � <br />SUB TOTAL 9 - <br />PERMIT 8 <br />TOTAL FEE 5 <br />FEE � AECEIPT O <br />-- G- <br />VALUATION F E <br />O10 <br />/ I� <br />ini,: _ <br />� <br />� <br />� <br />