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. . . . � . . . .. .. . . . . ._ � ... . � .. . '(�.'... ..... " ...��.�. i <br /> APPLI�A'�iON FOR CONSTRUCTION PERMIT <br /> everett <br /> fhe Evnrgreen � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INX—PLEASE PRINT <br /> 259-8810 '. <br /> ❑ DEMOLITION I.I COMBINATION I I BUILDING I I MECHANICAL CI PLUMBING ❑ SIGN <br /> OWNER MAIL ADOPESS GITY 21? PHONE ���A ��t/� i <br /> � � � Q � <br /> TENRNT MAILp�ORESS C17V 21P PNONE � <br /> AflCHiTECTOflDESIGNEfl MAILAD�RE55 / CITY ZIP PHONE <br /> � 4� � <br /> GENERpLCONTFAC Fi / MAILAODRESS ( SCITV. /Z'IP, PHONE /t UCENSEp j <br /> �CH�IN�i'/�N���6/ ����OflESS�/ ?�� (.!/• (/lC����/ �/���// IJE/T/lNGU7�y�z�ys � <br /> ,�'��} — - <br /> PLUM9INGGONTRACTOP MRILA��RESS CITY 21P PHONE LIGENSEX <br /> ClAS�RK i <br /> ❑ NEW ❑ ADDITION �ALTERATION I l REPAIR C I DEMOLITION I. I WOODSTOVE/FRPL INSEFT ❑ BUILDING RELOCATION <br /> TENANTIMPROVEIAENTOPINT'RIOflflE�/MO��EpL�ONLY CONTALTPER ONANDPN NENO. � <br /> CONTflpCTPRICEOFWORK:���f/ /�'JJ, OO <br /> DESCRIEEV�DRKANDSOUP9EFOOTAG INVOLV D <br /> PPOPOSGPU E BUILOING I HEREBY CERTIFY THAT I HAVE READ AND EXAMiNED THIS j <br /> ����� Ap� �� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL '� <br /> LEGpLDE�S F�PT��NOF6Pp��SHOWNOELOW ORATTACM FOl1R COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OP �. <br /> WORK W!LL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK op NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY i: <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORILED BY THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORY. FOR WHICH <br /> APPLICATION IS MACE AND I COMPLY WITH THE STATE I��� <br /> CONTRACTOflS LAW 18.27 RCW AND 296.200 SNAC. <br /> � � SIGNFTUIlEOFCONTflACTOfiORAUTHOPREDAGENT DATE l, <br /> i <br /> G - G� , <br /> 3 0 �' <br /> PROJECTR�DRESS APP��E NTSCITVBUSINESSL ENSENO.PNDBUSMESSNAME � <br /> / <br /> � ;MECHANICAL ! <br /> PLUMBING �� <br /> NO. TYPE-OF FIXTURE OR ITEM FEE NO. TYP EOUIPMENT FEE i <br /> WATER CLOSET(TOILET) � A/C—AIHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UMIT HEATERS—B.T.U. M � ��_� <br /> SHOWER CLOTHES DRYERS � i, <br /> KITCHEN SINK 8 DISP � VENTILATION FAN �_ ; <br /> DISHWASHER RANGE I100D � 4 <br /> LAUNDRY TRAY ; WATER HEATER _ � <br /> � <br /> CLOTHES WASHEFl � _ WOOD STOVE � � <br /> URINAL ' _ METAL FIREPLACE 8 CHIMNEY ' � <br /> DRINKING FOUNTAIN � PIREPLACE INSERT �_ � <br /> FLOOR DRAIN HEAT PUMP ' ' <br /> BACKFLOW PREVENTERS i GAS PIPING � I <br /> FOOF DRAINS—RAINLEADERS ' <br /> EXHAUST FAN ' � <br /> SINK(SERVICE—BAR,ETC.) I f ; 1 <br /> _�— <br /> ; ' i <br /> _ <br /> i <br /> i �— <br /> i <br /> i <br /> SUBTOTAL $ ' SUBTOTAL $ ' 1� <br /> PERMIT 5 � PERMIT $ � _ <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> REGEIPT NO <br /> FFONT SETBACK REAfl SETBRCK SIOE SETBACN PIAN CgEGR N �ER y FEy��� � 3 3 33 0 <br /> - STi+JCr ' `�v <br /> usezor+ LOTAflEA VACRNTSITE � ,�( EES VALUATION FEE <br /> �.� �� I.I YES Y ��0 BUILDING � VQ(J (_.C��—1 :�IJ <br /> 7YPEOFCONST.PILOWABLE 7VPEOFLONSiACTUAL Ottuc�xtt xoaoW[luHGUNm � <br /> cnour `, p�UM81NG ^_ <br /> i <br /> i <br /> SREOFOLOO. NO.O`Si9RIES BASEMENT MECHANICAL � <br /> IJ YES IJ NO ; <br /> OCCUPRNCYLOAD FIR!SPflNNLER5RE0'D HEIGHTLIMITATION OTHER � <br /> �J YES ( 1 NO STATE BUILDING SUfiCHARGE `-1 'T(� <br /> REASON FOR SPPINKLERS � <br /> STATE ENEFiGY SURCHARGE � <br /> i <br /> APPLICATIONACC.BY PV11 ❑ F� CITYOFEVERETf PUBLICWORKS � <br /> LOCAL SALES � <br /> TAX COOE IS 3105 TOTAL ' <br />