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i <br /> APPLI�GwT10N FOR CONSTR.��'CTION <br /> PERMIT <br /> fhe Evergreen <br /> CITY OF everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED I`l INK— PLEASE PRINT y8i ,�6 8� <br /> ��E�^ IKVC /D Ty/\T trMAI�RES� G�IY� � �C Jr�7O � rOl/ 'Y II W�N.lG I�'�/ /I � <br /> -��� � MPILAD�FESS Clir ZIP P ONE <br /> �i �Gin��u / � � MunSO� � ?3 /y� �t rC �s-�CWA ys/!/o `1Qo12 <br /> �. �, MAILAD�RESS CITY ZIP PNON[ <br /> ��o� Ur�al�..,.�..� � G••s'+��c�•,,, G �.c i'�4�_� Co�G /I wc...� IE ,60�// �..idq6on <br /> GENERRLCONTRRCTOli MPILAOOFE`S G',iI 21P �� PNONE LICENSEe <br /> `/�'/ 76p�/ � <br /> IAEGNRNICRLCONTRRCTOR MAI.�ODRESS CI'�V Z�P PMONE IICENSE• <br /> f�orr 7�„ ��t4'�'� ' <br /> PLUNBINGCONTR�CTOR � MMLrlOURFSS CIiY ZIP PNONE UCENSE� ,, <br /> _�I� _ <br /> . :�L.//SS OF WORK I <br /> � IZI�JEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOUTION ❑ WOODSTOVE/FRPL INSERT ❑ BUII.DING FELOCATION �, <br /> TFNINTIMPpOVEMENTORINTERIORFEMODEIONLY�J�j /'�7�y�� � CONTf.GTPER50NRNDPNONENO. � <br /> � WNTRAGT PRICE OF WORIe I / �/ ��C�J - <br /> DE�GRIBE WONN RNO SOU�RE FOOTAGE INVOLVED <br /> . vr�or� eDUseoFem� iNG IHEREBYCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> 7 KNOVJ?HE SAME TO dE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> ; �ec� ESCRI T ONOF PROPERTY�SHOWN BELOW O-/R PTUGN FOORGOPoC51 ORDINANCEP GOVERNING THIS TYPE OF WORK WILL BE COMPLETED N'ITH <br /> �or 3tocK or � Q �e�� �}1 WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> �E/ ��C�� PRESUMETOGIVEAUTHORITViOVIOLATEOflCANCELTHEPROVI510N50F <br /> �— ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> FORMANCE OF CONSTRUC:ION.iHAT I AM AUTHORIZED BV THE OWNER OF <br /> � THIS PROPERNTO PERFCfiM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND 1 COMPLY WITH 7HE STAtE CONTRACTORS LAW 1827 RCW AN� <br /> 29G200 WAC. <br /> SIGNAfU9EOFCONTPACTCROFAUtNOFIZEOAGENT pATE <br /> PROJECTAODRE55 w �� ��� r <br /> RPPLIGA . vBUSWE LIGEhSENO.ANDB115WE55NAME <br /> D �� <br /> PLUMBING M�CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATERCLOSETfTOILEn A/L'—A/HNDLGUNITS—H.P. <br /> - BATHTUB '"' FORCED AIR SYSTEMS—6T.U. M EA <br /> ' LAVATORYIWASHBASIN) UNITHEATERS—BT.U. M <br /> SHOWER — GLOTHES DRYERS <br /> , KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RFNGE HOOD <br /> LFUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER � �NOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAM FIREPLACE INSERT . <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF�RAINS—RAINLEADERS E%HAUST FAN <br /> � SINK;SEPVICE—BAR,ETC.) <br /> SUBTOTA�_ S — SUB'fOTAL 5 — <br /> PERMIT 5 PEPMIT 5 � <br /> TOTAL FEE 5 — TOTAL FEE 5 I <br /> FPONTSEiWGK FCARSEt9RCK SIDESEiBALN� FUMNCNE NNIIMOER FErE �3� NECEIPTNO. �, <br /> � l � ' 7 ., V 1 � v�`_ �� � <br /> usezoN �.oran� vnenr�Tsire FEES VALUATION FEE � <br /> �— ❑YES ❑ NO � <br /> TYPEOFCONS . OCCUPBNGYGFOUP NO.OFDWEIIINGUNITS BUILDING <br /> �3c� 5 � <br /> �LLOWABLE/ACiOAL PLUMBING , <br /> SIZE OF BLIX'i NO Oi STORIES &SMl'. OGG IOAD �� � <br /> 3TSL Sfff 4 iJ KY MECHANICAL _ ��, <br /> ` N <br /> HEIGMTLIMITAiION OTHER � <br /> ! <br /> FIRESPRINNIEPSNEOUIRED ❑YES ❑ NO � STA'iEBUILDINGSURGHARGE � � ' <br /> STATE ENERGY SURCHARGE <br /> APPLILATIONA 6Y PLANSPPPfl.BY <br /> < / � PUBLIC WORKS <br /> �'y',� � TOTAL C� � ��J <br /> � �'/ S'st� �l5 �� � ��ni r ' � <br /> o ���ctn. �k f�� . <br />