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APPLICAI �ON FOR CONSTRUe, iION PERMIT ����P« <br />T <br />�he Evergmen O BE COMPLETED IN INK—PLEASE PRINT � <br />arv oF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTR�C ❑ � <br />BUILDING DEPP,RTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />OWNER MAILF�DFESS <br />� r,,. � �2� ��st ,3 �� � <br />TENFNT � AIAILAODRE55 <br />BUILDING <br />CITY <br />GTV <br />MECHANICAL <br />ZIP � „ PHONE <br />ZIP <br />PLUMBING SIGN <br />nHCNIiEGTORDE5IGNER h1�lI.ADOPE55 CITY ZIP PHONE <br />GENERALCONiRFCTOR MAILPOORE55 CITV ZIP PHONE LICENSEx <br />MECNANICALCONTFACTOfl h1FILn�OFE55 CITV 21P PHONE LICENSEe <br />1�M.cv'c�y ���:-n ? 2aN NG/13 �l 54�Lc 98' /1r �»s3 Y i4/wl1� // 2/2.rc. <br />PLUM�INGCONiR�CTOR AMLA�DRE55 CITY ZIP PHONE LICENSEt <br />C�A�S OF VIORK <br />�. �. NEW � ADDITION X ALTERATION .�� REPAIR . DEMOLITION . WOODSTOVE/FRPL INSERT ,_ -. BUILDING RELOCATION <br />I CONTACT PER�N ANC PHONE NO� <br />UESCRIFIE WORHAND S�UFRE FOOTAGE INVOlVEO <br />PRO���G <br />r <br />LEWL �ESCRIPTION OF PROPERtt �SHOWN BEIOW <br />l0T _ . BLOCN _ OF <br />PROJECTADORE55 <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHObVER <br />KITCHEN SINK R DISP <br />DISHWASHER <br />LAUNDRI' TfiAl' <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />I HEREBY CERTIFY THAT I HAVc READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOURCOPIES� PFOVISIONS OF LAWS AND OFDINANi,ES GnVERNING THIS TYPE OF <br />WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME i0 GIVE <br />AUTHORITY'f0 VIOLATE OP, CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL I_AW REGULATING CGNSTRUCTION OR THE <br />PEFfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOP.M THE WORK FOR WHICH <br />APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNF7UriEOFCONTRACTOflORAl1THORREDAGENi DATE <br />�/� —C� �"�+n <br />APPLICANTSCI USINESSUCEN p.pNDBU5MES5NAAtE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFPICE USE ONLY: <br />FRONT SETBACK REAfl SETBACK <br />USEZONE LOTFREA <br />iYPE OF GONiS ALLOWABIE iYPE Of CONSi ACiOAI <br />SIZE OF BLDG. NO.OF STORIF.S <br />OCCUPANCV LOAO PIRE SPRNKLERS REC <br />aEASON FOR SPRINKLER$ <br />'N14HE�Y PLANSFPPROVEDBY <br />NO. TYPE OF EOUIPMENi <br />A/C—A/HNDLG UNITS-4.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />i UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />' VENTILATION PAN <br />� RANGENOOD <br />� WATER HEATER <br />WOOD STOVE <br />METP.L FIFEPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />9_ EXHAUSTFAN <br />SIOES[TBACK PLANCHECKNUMBER <br />VACFNT SIiE FEES <br />BUILDING <br />OCNPSNCY HOOfpN'[LUIGU!u15 - <br />saouc pLUMBING <br />BnSEMENT MECHANICAL <br />NEIGHTLiMiTqTiGN ADDITIONALPLANCHECR <br />O7HER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOi,AL SALES <br />TAX CODF IS 3105 iOTAL <br />SUB TOTAL 5 Q <br />PERMIT $ / S <br />TOTAL FEE $ �. �/� <br />NO. <br />FEE <br />�� <br />2 y5 � O�� <br />i <br />T <br />i <br />T <br />� `)5;n7` <br />