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APPLICATIt.N FOR CONSTRUC1.0�1 PERMIT <br />Ihe Eveigreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COfdPLETED IN INK—PLEASE PRINT <br />Ll DEMOLITIO�! CI COMBIIJATION I I BUILDING LIMECHANICAL <br />OmWNER MAILAOORESS CITV �IY PMONE <br />J/-�,�j'/ S i� P�.t�,r5�7as� �;.�„zr:,c�� �'J'��fH �7z,55 z <br />TENANT MAIL AD�RESS f,l� CITV 21P PNONE <br />f/'_„�i�..�„1 �d�� �1'� Ibl- Av,ri-�� C,% �i'72'7d : <br />MI�IL ADDRESS <br />CITV <br />PHONE <br />everett <br />� <br />I J PLUM6ING �Y SIGN <br />- y3b -(�sab <br />� — ��G� �rJ�l <br />GEt�;CpN�F�I�� MAtT�l9ssC � I%I� 1G✓II V" �Z�Z�� "'�N�J4'YI�L.LIG`�L-1I.lR�iF.�I��/ <br />�M <br />MECHANICALGONT qCR MRILA��RE55 CI Z�P PHONE LICENSE� <br />PWM9INGCONTRRCTOA �-'�•�iADOPESS CITY 21P PHONE IILENSEY <br />GU550F WORN <br />D� NEW ❑ AODITION ❑ ALTEF�AI I0N IJ REPAIR LI DEtdOLITIOPJ [ 7 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPrIOVEMENTORIVTERIONRElA00ELONLV C� /� GONTRCTPEfl50NRNOPMONENO. <br />CONTPACT FflICE OF N'I]RK_ _ � �� . /�y .___ <br />DESCFIUF. WOflK AND ^u]UAFE FGOTAGE INVOlVEO <br />Muv� Q� �. L� �1 �tu - Sw,..�-- <br />, <br />PROPOSF.D USF. O? Blll�_DING <br />�EGA� UESCRIPTIOk CF PROPGRTV �SHOWA BELOW OR ATTACN F'OUR W PIES� <br />ioT .. ___ oioce or __._ <br />FLUMBING <br />O. TYPE OF FI%TI <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />K!TCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />ROOF ORAINS—RAINI <br />SINK (SERVICE—BAR, <br />FPONTS2TBAGK <br />� <br />USE Z6fjE _ <br />\. <br />iVPEOFCONSLAL OWABLE <br />SIZE OF BLOG. <br />OCGUPqNCY�OAD <br />REASON FOR SPFINKlERS <br />APPLICATION ACQ OY <br />I HEREBY CERTIFY THP.T I HAVE fiEAD AND EXAMINED THIS <br />APPLICATION AND KNONJ THE SAME TO BE TRUE AND CORREGT. ALL <br />f•ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERLIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLAT= OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CG:JSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br />APPLICATION IS MA'JE AND I COMPLY WITH THE STA7E <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. J <br />SIGNfy3URE OF CONTFAC70H OR AUTHOFIZEO FGENT DATE ���� �1 <br />LIGENSE NO. AND <br />/ � MECHANICAL <br />OR ITE3M FEE NO. TYPE OF EGUIPME <br />� A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T <br />--;— UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />SUB TOTAL $ ' <br />PERMIT $ —�— <br />TOTAL FEE $ ; <br />REAR SET�ACK SIOE SETOFCK <br />� � <br />LOTAREA VACANTSITE <br />I.1 YES f-I NO <br />TYPEOFCONSTALIUAL o[curucr r,Jn�awuuxci <br />ceaut <br />NO.OF STORIES 9NSEMENT <br />�] YES I I NO <br />FIflESPRNNLERSflE00 HEIGMTLIMITATION <br />IJ YES I I NO <br />PLANSAP�ROVEOBY CITYOFEVERETT <br />�/% LOCAL SALES <br />� � TAX COUE IS 3105 <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INS[RT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CMECK NUM119Efi <br />BUILOING _ <br />PLU618WG <br />MECHANICAL <br />OTHER � <br />STATE BUILDING SURGHARGE <br />STATE ENERGY Sl1RCHARGE <br />PUBLIC WOFHS <br />TOTAL <br />FEE <br />SUB TOTAL $ ; <br />PERMIT 5 � <br />TOTAL FEE $ ' <br />FEE RECEIPT NO. <br />VALUATION FEE <br />_ r �. ,r �� ; � <br />i <br />i <br />i <br />i <br />� <br />1� il _ _ <br />i <br />i <br />-� <br />i <br />i <br />__ � <br />i <br />�i •' <br />�T � <br />' "� <br />1� <br />