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N� �� <br /> ' APPLICATIOnI FOR CONSTRUCT JN PERMIT � <br /> � everett �� <br /> the Evergreen � <br /> CIN OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION i=� COMBINATION �BUILDING C; MECHp,NICAL ❑ PLUMBING ❑ SIGN <br /> OWNE '��.I����11 MAIVIoEt��]YI�hG1UH7lVp C�U 1�'.�� Z' IOh/J 353-Z�Iqb <br /> TENANT MAILAD�RESS CITV ZIP PHONE <br /> RGHITECTORD �NEF p".A�DRESS CITV IP PHONE <br /> �, �ohs �ohc �q►i s�p3-10 S}. �luk��r,, ��275 7�-�5 .1� <br /> PiENERAL NTRACTOR AILADDflESS GITV ZIP PHONE LICENSEN <br /> �l� � i ���1J1o1� _ <br /> MECH YI ALC NTRACTOR MAILADDRESS CITY ZIP FMONE LICENSEA <br /> PLUMBINGCONTRACTOR MAILADDFiE55 CITY ZIP PHONE UCENSEI <br /> � �C SSOFWOFN <br /> NEW I� ADDITION f� ALTERATION ❑ REPA�R ❑ DEMOLITION C! WOODSTOVt/FPPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT Ofl INTFRIOR FEMODEL ONLV CONTACT PERSON AND PHONE NO. <br /> � CONTN�CTPRICEOFWORK: / G S �l' �S�D <br /> OESCflIBE WORK AND SOUARE FOOTAGE INVOLVED , <br /> � pqpPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> : S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALDESCflIPTIONOFPflOPERTV(SHOWN BELOW ORATTACM FOUF COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � �or B�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �U _ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � QI�I I OZOLZ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �. /1 Q 4 '� • � I CONTRACTORS LAW 7827 RCW AND 296 200 WAC. <br /> � �;� SIGNATUREOFCONTRACTOPOFAUTHOP2EDAGENT DATE <br /> ' �/Lf�/ V YN <br /> P F' '7D ES j ��� i I '� r�, Y e qpp�ICANTS CI�USINESS LICENSE N0.AND BUSINESS NAME <br /> 1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> �' WATER CLOSET(TOILET) � A/C—lVHNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> ' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DI§P � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ; WATERHEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE 8 CHIM Y ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREV TERS � GAS PIPING � <br /> ROOF DRAIN AINLEADERS � EXHAUST FA � _ <br /> SINK(SERV —BAR,ETC.) � � <br /> � � <br /> � � <br /> � � <br /> � <br /> � <br /> SUB 70TAL $ ; SUB TOTAL $ ' <br /> PERMIT $ —� PERMIT $ T <br /> TOTALFEE $ TQTALFEE $ <br /> FRONTSETBA K flEARSETBACK SIDESETBACN� PLANCHECKNUMBER FEE ,.3/ � � RECEIPTNO. <br /> � F a ' � 9c ay �d s 9�. L � 3 �s7o <br /> USE ONE LOTAPEA VACANTSITE FEES VALUATION F.iE <br /> — � �i YES '�� N� BUILDING � Cj `J/ ' 00 <br /> 7VPEOFWNST.ALLOWABLE TYPEOFCONSI.ACiUAI o[Cuv�xtr HoorOwEIUNGUxus � <br /> �_� _, cnouv p�UMBING $5G0 — � <br /> SIZEOFBLDG. NO.OFSTORIES B�SEMENT MECHANICAL Cv — � <br /> �449 0 + G6R Z '.-! YES X NO � <br /> OGCUPANCYLOPO FIRESPflNKLERSREO'D HEIGHTLIMITqTION OTHEF�_��' , Q � Y <br /> L YES bC NO � � � <br /> STATE BUILDING SURCHARGE '� <br /> REASON FOR SPiiINKLERS I <br /> STATEENERGYSURCHAFGE � <br /> i <br /> APPLICATIONACC.BY PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS �'Q �OG <br /> • ,9�?f LOCAL SALES i r- <br /> 4 Z� TAX CODE IS 3105 TOTAL .�35 � 9 <br /> (�B `t, �i ( <br />