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t <br /> ��: APPLICAT101:°�FOR CONSTA�UCTI'i;'N PERMIT �VeiE'« <br /> me Evergmen TO BE COMPLETED IN INK—PLE118E PRINT � <br /> CITY OF <br /> eve rett ( HEATING SYSTEM: GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMEwT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING ��MECHANICAL �A'PLUMBING SIGN <br /> � MAI n ONE55 P110NE <br /> „�L�1�1�► '��- � � F� � , >f C�,r�:ti u�'a. ;���- 3 g� � �ao� <br /> IEN�Ni �MnILAD�R 5 pTY 21P PHONE <br /> nf1�HIlECi0RDE51GNE� MM�AL�DRESS CITY ZIP PIIONE <br /> � <br /> �HNFfI4LGONipAClOf1 M4ILADDRE35 CITY LP PP01lF LICENSE� <br /> FCN NICALCONIMGIOfI MALAODRE55 C Y UP HONf <br /> �ur� �,� �l_c�l-� , -r��, 3110 � I� HV�V�,�p,��efl 1.���� t�.�-S3� ��E. ,�I�(���� <br /> . 1lUAl0iNGCONTR�C1011 M411p00RES5 ��Ty Z�� <br /> PIIONE UGENSE� <br /> C SSOF WORK — <br /> �NEW ADDiTION ' ALTERATION REPAIR .�, DEMOUTION WOODS70VErFRPLINSERT :_� BUILDINGRELOCATION <br /> V CONT�Ci PEt1SON�N�PHONF NO <br /> GONTRACT PRICE OF WORN '�� I��.�U <br /> U[SCRIBEWOHkAND50U�R FOO7�GEINVOLVEO <br /> ` C �u�i� � �� ' <br /> �---��,�� <br /> I.��_-1;� ��.-�c..�'�i i:ir i� <br /> � <br /> ('n � eIoq n.owc � I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> '�nJ n APPLlCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �Fcni�n�rr���nao�Enrv ;�� wl I�t��yOR RTT�f.N��co���rv �- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> oi AicH;h oF WORK WILL BE COMPLETEO WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ' - _ OTHER STATE OR LOCAL LAW qEGULATiNG CONSTRUCTION OR THE � <br /> - ^ PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> f�X��_� OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> ��"�—'� --- -�— APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> ; CONTRACTORS lAW 1827 RCW AND 296.200 WAC. <br /> _ SIONntU11CO�C(N�O1pp1UlIONeUI110N12ED�GENf D�iE <br /> 1— L._' <br /> t����.o�ssl � , ��1�! .� I i '��•� x � . ,��.� ��, �� C�—�-�'��l <br /> �PPLICA f5GiY0USINE55UCEN5ENO �NOB ESSN�IAE <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET(TOILET) ___ _ A,'C-A�HNDLG UNITS-H.P <br /> BATI�TUB FORCED A�R SYSTEMS-B.T.U. M E.A. <br /> __ LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> _ SHOWER CLOTHES DRYERS <br /> _ KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRV TRAY ___ WATER HEATER <br /> CLOTHES WASHER ��� � WCIOD STOVE <br /> URINAL ; METAL FIREPIi+CE 8 CHIMNEV <br /> _ DRINKING FOUNTAIN � FIREPLACE INSERT <br /> _ FLOOR DRAIN HEAT PUMP <br /> _ BACKFLOW PREVENTERS _ _ GAS PIPING <br /> _ ROOF DI7AIN5-RAINLEADERS E%H�US1 FAN <br /> _ SINK(SERVICE-OM.[fCJ ---�--'-' �- � --�------- - — <br /> --- -�-- ----- ' <br /> --. . .. .� —------------ <br /> _ ; <br /> � <br /> _ SUB TOTAL $ ' SUB TOTAI S "' <br /> _ PERMIT $ _ —r— PERMIT g <br /> TOTqL FEF S ^ ___ �_ , _ TOTAL FEE 5 �) _ � '� <br /> FOR OFFICE USE ONLY: � �� — -' ` — <br /> ��ON�SEt��CN qE4q5El0ACN SIDESETB�^K PLAHCNECNNUMBER FEE <br /> RECEIPT NO <br /> �,sc zor�e tor nnen vncnrii Sire FEES VALUATION FEE <br /> ����'cov�5 nu0w�pu rrof ot coi�st�cr n � -- BUILDu�G � <br /> � � ry.Cll��� •��1 M(ry��Il1Y(�11Y�1{ ._� _J <br /> fuQ i <br /> PWMBING <br /> ':i]F 0��LUG __-- --___ ___�_' <br /> NO OF 510��E5 BASEIAENT — <br /> MECHANICAI � <br /> OCCUPANCV LO�U FIRE SPfiNNLE�S�EOD NEIGNI LIMII�iION �DDITIONAL PLAN CHECH � <br /> i <br /> �rt n5on FOn Sonrt�K�k��s <br /> oTHEn � <br /> STA7E BUILDING SURCNARGE <br /> �—i-- <br /> uuv[or�---�-- ---- --��m�s nrrnoveDev CITY OF EVERETT PUBL�C wORKS <br /> LOCALSALES <br /> TAX f,O�E IS 3105 rorn� <br />