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APPLICATIO�rI FOR CON�TRUCTi N PERMIT everett <br /> fheEvergreen TO BE COMPLETED IN INK— LEASE PRINT � <br /> CITV OF <br /> everett HEATING SYSTEM: . GAS ❑ELECTR C ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION u BUILC�ING � ECHAMCAL ❑ PLUMBING ❑ SIGN <br /> OWNE MAILADORESS CITY Z�F PHONE <br /> ��� Ln�l.S.IS _vAe�s. �+� 96zo3 , 2Ss Z�9 _ <br /> � r <br /> TENANT �� MAIL�DDRESS CIT ZIP PHONE <br /> � <br /> ARCHITECTORDESIGNER MAILRDOfiE55 :�7Y Z�F PMONE <br /> GENERALCONTRACTOR MAILADDRESS CIN ZIP PNONE '.ICENSE� <br /> MECH 11 ALCUNTMCTO MAILAODFES LITV ZIP PHONE LICENSE� <br /> PLU T CTO MAIL ODRES� ���� /�.ITV �l• , ��� / ���ON�����/���� <br /> yv <br /> C WORK <br /> ❑ NEW ❑ ADDITION . ' LTERATION ❑ REPAIR L DEMOLITION L 1 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> �/��I/�/-�� CONTACT PERSON AND PMONE NO. <br /> CONTMCT PRICE OF WORK WV •� <br /> DESCPIBEWORKANDSOU AGE VOLVED <br /> � 1tS t !!r' <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � LEG�LDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHFOUPCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> �� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> " ior e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��� _ AUTHORtTY 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 AUTHORI:ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FGq WNICH <br /> . APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 2%.200 WAC. 2��6 � <br /> ' SIGN:fOREOF�ONTRACTOROR�UTHOHIZEOAGENT DATE � / � <br /> X �,,�i.Q ��q�����j <br /> ' PRQIECTADDRESS y ^ . <br /> 'S G/� �SS �PP��LANTS CITV B��SMESS LICENSE NO.AND BUS 55 NA / <br /> PLUMBIN(i MECHANICAL <br /> � NO. TYPE OF flXTURE OR REM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C-A/HNDLG UNITS-H.P. � <br /> BATHTUB � ; FORCED AIR SYSTEM .T. M E.A. ; <br /> . LAVATORY(WASH BASIN) � UN�T HEATERS-B.T.U. ; <br /> - SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> � LAUNDRY TRAY ; WATER HEATER ' <br /> - CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> RnOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> — —� <br /> SINK(SERVICE-BAR,ETC.) ; ' <br /> � <br /> � <br /> � � <br /> � <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ p '- <br /> PERMIT $ � PERMIT $ �J'� - <br /> TOTAL FEE $ ' TOTAL FEE $ SS' <br /> FOH OFFICE USE ONLY: <br /> FRONTSETBACN REARSETBRCK SIDESETBpCN PUNCMECNNl1MBER FEE RECEIPTNO. <br /> USE ZONE LOT AflEA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> TVPE Oi CONiS.ALIOWABIE NPE OF CONSi.ACTUAL accuPu,Cv HO of mviluNGunrtS � <br /> LRWP pLUMBING ' <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL sri0o <br /> OCCUPANCY LOAO FIRE SPRNNlERS REO'D HEIGMT LIMITATION AODITIONAL PLAN CHECK � <br /> OTHER � <br /> REASON FOq SPRINKLEFS <br /> STATE BUILDING SURCHARGE <br /> INTANEBY PIANSAPPROVEDOY CITYOFEYEREIT PUBLICWORKS � <br /> LOCALSALES <br /> TAX CODE IS 3105 TOTAL S,� � au <br />