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- QPi�LICATI�..rl FOR CONSTRUC7 .JN PERMIT <br /> everett <br /> fhe Evergreen � <br /> CITY OF <br /> e�rerett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I I DEMOLITION I i COMBINATION i I BUILDING I I MECHAtJI�AL I I PLUMBING I SIGN <br /> OWNER MAIL�DDRE55 CIiY ZIP P��ON[ <br /> G'i �� 335 iib'"M�� S� /�ucSrruc l.�rq Qf�o� 9yo '" 5 52-5 <br /> TEN4Nt � M�IlAD0fiE55 CIiV 21P PHOtlE <br /> �,� �,���� �.��,� ��� ��c� ��A��� .�G 9,���/ <br /> �BCHI7E TOR�[SIGNE(i MAILADDRE55 % CIIY ZIP PMON�2� �,ZP� <br /> U GENEPM1LGONTR�C70R M41lA�ORE55 QtV ZIP PHONE ��CENSEr <br /> � 5 �G,v � i3irjo �,�� ,q-c�,(/ �EA-� ��i 9�/33 36i-ozyZ SSSZ-ri-�1 /3iCu <br /> MF:GANIC�LCONTf�AGTOfi MAILAODRESS ��t� ZIP PHONE UCENSEY ' <br /> PLUMOINGCONIR�CIOII MAILADDB[SS CIiY ZIP PHONE LICENSEN <br /> ClASSOf WOf1K <br /> I✓NEW I I ADDITION I i ALTERATION I i REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> TEN�NT IMPROVEMGN�Ofi INTERIOP 0@MOJEL ONLY GONT�CT PEyRASOIJ�N/D,PI/ION[N,�0y. �' <br /> CONifiACT PBICEOF WORN: I�b� s4 ��/�/ �V�v'/9„� <br /> OE.SGBIOG WORH�Np SOUME�OOtpGE INVOLVED . <br /> «sa�u� 2 u�r.�Hovx� vi<•�c�s 36�-a 2��— <br /> Pli0PO5EDUSEOFOUIL�ING i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> l,�� APPLICA'ION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> d'f PROVISIONS OF LAWS�ND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL OESCPIPiION OF FfiOPERiY(SHOW N�[LOW Op ATTAGII FOUFl COPI[S� <br /> WORK WILL 6E COMPLETED WITH WH[THER SPECIFIED HEREIN OR <br /> ior o�ock or NOT. THE GR�NTING OF /1 PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� �9L��� OTHER STATE OR LOCAL L�W R[GULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCT�ION.THAT I AM AUTHORIZED BY THE <br /> � OWIJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WI"!H THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> sicNnruneorcoNtnncTononnumomzeon��NT ont� <br /> � <br /> X <br /> rI1oJEc1 nDunE55 — <br /> `�� �G �� 'l� �� • AVPLIC Ni$.0 Sltl�SSLIC[NSfJJO.�tJU1llI51NES.5N M <br /> L /•Z J CO LZ7S <br /> PLUMBING ME ANI AL <br /> NO. TYPE OF FIXTURE OR ITEM F[E NO. TYP[OF EOUIPMENT FEE <br /> WATEFi CLOSET(TOILET) NC—A/HNDLG UNITS—FI.P. _ <br /> BATHTUB ; FORCED AIR SYST[MS—B.T.U. M E.A. <br /> LAVATORY(W�SH BASIN) i UNIT HEATERS—B.T.U. M �_ <br /> SIiOWER _� _ _ CLOTI-ICS URY[f1S _ `_ <br /> KITCI-IBN SINK 8 UISP � i V6NTILAI'ION 1=AN i <br /> __ �— —— �_— <br /> DISHWASIIER RANGE I-IOOU _ � <br /> — ' WAT[Fi H[ATER ' <br /> LAUNDRYTRAV —— , <br /> CLOTHES WASIIER ---��— WOOD STOVE � <br /> •-- <br /> URINAL METIIL FIR[PL�C[8 CFIIMNEY ' <br /> DRINKING FOUNTAIN � _ FIREPLACE INSERT _�_ <br /> FLOOR URAIN � H[AT PUMP � <br /> 6ACKFLOW PREVENT[FlS ; GAS PIPING <br /> ROOF DRAINS—RAINL[�D[RS �— EXH�UST F�N � <br /> SINK(SERVICF—�AR,ETC.) ' � <br /> —_ �r— i <br /> — i � <br /> _— _ i <br /> ----�i —�_ <br /> —— <br /> SUB TOTA: $ ' SUB TOTAL 3 ; <br /> PERMIT S --�_ PERMIT $ � <br /> TOTAIFEE $ ' ' TOTAIFEE 5 ' <br /> FBONiSETp4CN REAf15[IA�CN SIUESEi��CK �'LANGI [�( MOEfI� FG[ � �J ��CEIPTNO. <br /> � �� l� <br /> USE�ONE �toYnncn vncnutsire ,L FEES VALUATION FEE <br /> - 2 Z/�pJ�M/rl I I YES /V� NO OUILDING � � — <br /> lYPEOFLONSf.ALlOWA1LLF lYPE0LG0115f.A;WAL a[�urnnr.v hootUwaur uun6 — �— <br /> � <br /> r�nour PLUM�ING i <br /> i <br /> SIZEOFOIUG. NO.OFSIORIES CASEMEN7 MECHANICAL � <br /> ' I YES I I NO � <br /> � <br /> OGCUPANGYLOAD FIBESPRNKLERSREO'D N6 TLIMITATION �THER � <br /> I I YES I I NO �(_, t�� STATE BUlLUING SURCHAfiGE � ;� <br /> RE�SON FOR SPRINKLEf15 � <br /> STATEENERGVSURCH�flGE <br /> nvrucnriouncaov r�nHsnrenoveuov CIJYOFEVERETT PU�LICWORKS <br /> �LOCAL SAI FS {� � <br /> �M II Z �C TAX CODE I' 95 TOTAL � <br />