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�'� � 'x•` <br /> APPLICAT�iiiN FOR CONSTRUC`r-i�'ON PERMIT <br /> everett <br /> the Evergreen <br /> CITY OF � <br /> ever�tt . � <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> l 1 DEMOUTION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL O PLUMBING ❑ SIGN <br /> OwNER MAILADORESS CITY ZIP PHONE <br /> �<lewr/s1 G'liQs� �7/Z Orir/��f�e,C�, f..�r�rt`f 8,l'0 ??�'E /45 <br /> TENANT MAILA�DRESS <br /> ARCMIiECTORDE510NER MAILADDRESS CITV ZIP PHONE <br /> �ENERALCON7RACTOR MAIIRUDRESS CITY 21P PHONE UCENSE� <br /> MECHMIIC�LCONTflACTOR MAILAD�RESS CITY ZIP PHONE LICENSEI , <br /> `�PLUMBINOCONTR�GTOR MAI��U�RESS CITY ZIP PHONE LICENSE• <br /> ✓\ OW��✓ <br /> CLR55 OF WORK <br /> I-I NEW ❑ ADDITION O ALTERATION ❑ REPAIR O DEMOLITION ❑ WOO�STOVFJFRPLINSERT ❑ BUILDIN�RELOCATION <br /> TENI1Ni IMPfiOVEMENT OH INTEPIOR REMODEI ONLV CONTACT PERSON AND PNONE NO. <br /> , � CONTRACT PRICE OF WONN: <br /> �ESCRIBE WORK/U!D SOU�RE FOOTAGE!I�!OLVED �. <br /> /D . �.ii7. TT '�'� �i%C <br /> P SEDUSEOFBUILDIN(i I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI ' <br /> � � <br /> �jn9�E ��� I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL AL . <br /> LEGAL DE RIPTqN OF PROPER Y(S4iOWN BELOW OR ATfACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE O <br /> - WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> i.or _ e�ocK oF NOT. THE GRANTING OF A PERMIT DGES NOT PRESUME TO 61VE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AN <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. � <br /> 516N�NREOFCONTRACTOROHAl1TNORREDA(3ENT D�TE <br /> X c:�yc , ��/ <br /> �Ri�'!/,2.lJ.r�/' �o.� ��. EdE.�'ft <br /> APPLICANTSCITYB NESSLICENSENO.�NUBUSINESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � AIC--NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(l^.'.4SH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES ORYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAPI ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAI ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFIOW PREVENTERS i GAS PIPING ' <br /> � ROOF DPAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> i i <br /> i i , <br /> i i <br /> i i <br /> i i <br /> SUB TOTAL S i SUB TOTAL S ' <br /> PERMIT $ � PERMIT S i <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FAONTSETBACN PEAflSETBRCK SIOESETDACN PUNCHECKNUMBER FEE RECEIPTNO. <br /> USEZONE �oranen VACANi51TE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING i <br /> tYCEOFCONStRLLOWABLE TYPEOFCONSI.PCIUAL acurextY xo.aoxtwxouNns � <br /> GNW1' � <br /> PLUMBING � <br /> SIZEOFULW. NO.OFSTORIES BASEMENT MECHANICAL , <br /> •LI YES ❑ NO � <br /> OCCUPANCYLOAO FIBESPRNNLEPSRE09 t1EIGHTLIMITATION OTHER i <br /> ❑ YES ❑ NO STATE BUILf'NG SUFCHARGE � <br /> — i <br /> PEASON FOR SPRINNIEflS <br /> STATEENERGYSURCHARGE i <br /> APPL�CATIONACC.BY PLANS�PPf10VEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES � <br /> TAX COUE IS 3105 TOTAL � <br />