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APPLICATII�N FOR CONSTRUG1�r�N PERMIT <br />the Everpreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8610 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION � BUILDING I I MECHANICAL I 1 PLUMBING <br />nwNEH MAII A�DRE55 GTV 21P PHONE <br />g <br />TENANT MAII.ADDf1E55 CITV ZIP PMONE <br />�'•-.�-�,o.✓ ,G�:f�,✓ SA�� AS A�3rdE- <br />�ARCHI ECTORDESIGNER MRILADDNESS CITY 21P PHONE <br />1'.tiO.ecfS�eN de�s�;.� uzy' .�eKSo�r E✓. 9871�3 35�i -3z o0 <br />GENER LCONTHACTOR MAIL�OONE55 CI1Y ZIP PNONE LICENSEt <br />SAw+E As o �u.�� <br />MECHIJlICALCONTRRCTOR AIAIL�DDNE55 CITY ZIP PNONE LICENSEt <br />PLUMBINOCIXiTRACTOR MAll�00RE55 CI7V ZIP PHONE LICENSEI <br />C! A55 OF WOAK <br />f�Q NEW ❑ ADDITION I I ALTERATION I I REPAIR <br />TENANT IMPROVEMENi OR INTERIOR REMODEL ONLY <br />X L: NTRACT PPIGE OF WORK: ��SJ . 4� A <br />� DESGRIBEN'ORNAN�SOUAREFOOTAGE <br />n I <br />� <br />'� D�J O—Cd <br />LOT /"S' BLOCK L�d� OF <br />PP0.IECTADDRESS <br />f�22.. �6�'CfZ �T <br />PLUMBINO <br />N0. TYPE OF FIXTURE OR ITEM <br />N'ATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SNOWER <br />J K�TCHeN SINK 8 DISP <br />DISHWASH[5 <br />LAUNDRY TP..4Y <br />CLOTHES'1r'�`.�HC9 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADEfiS <br />S�NK (SERVICE—BAR, ETC.) <br />FRONTSETBA;K <br />� <br />US ONE <br />tYPE OF CONSI. �ILOWABLE <br />SIZE O el <br />Z'I4 S { <br />064 s� G�ll? _ <br />occurnNcviono <br />F� <br />REASON FOIi SPRINKLERS <br />APPUCATION ACC. BV <br />�u Q��R y�NrN�I <br />PERMIT <br />TOTAL FEE <br />REAR S�TBACK <br />25 <br />�oranen <br />l, 00 `I' <br />TYPE f CONSi ACIU�I <br />\/- 'J I <br />NO.OF STORIES <br />Z <br />FlOE SPRNI(LGIiS fiFOD <br />I I YES L4 NO <br />L <br />roun r.ories� <br />$ <br />510_E6E�BALK /' <br />I 1 DEMOLITION I I WOODS70VFJFRPL INSERT <br />CONfnCT PERSON AN� PIIONE NO <br />f�„4 l,a,e✓Et 355- 5 �3�� <br />everett <br />e <br />O 31GN I <br />I I BUILDING RELOCATION <br />ss <br />I HEREBV CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PPOVISIO(JS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL L.4W REGULATING CONSTRUCTION OFi THE <br />PERFORMANCE OF CONSTflUCTION. THAT I AM AUTHOFiIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTPACTORS LA1V 1827 RCW AND 296200 WAC. <br />SIGN�TUREOFCON7RACTORORAUTIIORI2EOAOEN' OATE <br />X / ��N�. ��+✓� o��1Co.�Tn��^ <br />APPUCANISCITYBOSWESSIICEN NO.ANUBUSINESSN�ME 'y` <br />Of EOUIPMENT <br />FORCED AIR SYSTEM; <br />UNIT HEATERS—O.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTfAN <br />vncnNTsrte ' FEI <br />YES -fl NO BUi�owG�y <br />occurnr�cr MowvxF�l�Mcux��s <br />cncuv I <br />� PLUMBING <br />BAS[MENT MECHANICAL <br />I I YES r(1 NO <br />NEIf11I LIMITAI, N OTIIGR <br />SfAi B UUII.UING SUIiCFIAIiGG <br />STATE ENEflGY SURCfI�RGE <br />PLANSAr���EDOV CITY OF EYERETT PUBLIC WORKS <br />�1 LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />Of A�/S,S(1 tn� P(ha Clv!(c u,eP/�acJ k� ����/Dii+y <br />PERMIT $ <br />TOTAL FEE $ <br />FE��R flF <br />✓ <br />l tPB <br />FEe <br />FEE <br />i <br />� <br />N <br />