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•� �:1 <br />QPPLICAiIOi`I FOR CONSTRUC'I��+t�N P�RMIi' <br />1he Evergreen everett <br />CITY OF � <br />everett <br />BUILf,�ING DEPARTMENT <br />259-8810 TO BE COMPLETED IN I�JK—PLF.ASE PRINT � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILpING C MECHANlCAL C�lpLUMBING ❑ SIGN <br />OWNEfl MAI�A��flESS ��ry Z�P �H�N- <br />T�Nr~/c �t ��7 raai�ooa ss //S��f/ Ni'.�t.,.vri/c�. 2f(sL1r 7S]24 2i'� �a3—�rGf' <br />CITY ZIP PMONE <br />Pa�- � • <br />AflCNRECi0R0ES1uNER AILAODRESS CIT' � ZIP PMONE <br />�� <br />GENEflALCONTpRCTOfl MAILAOOqE55 ritv .�.. _____ — <br />. �....... �,.�r...,.cmon � �n,n, cnivn ncmwu unlr <br />CONTRRCT PIIICE OF WORK: <br />DESCRIBE WJflK AND SOUAfiE FOOTAGE INVMVED <br />PFOPOSEO USE OF BUILDING <br />_—�C�/V, ��S (�/'J <br />�EGPL OF.SCFIPTION Of PHOPERTY �SNOWN �ELOW Ofl ATfRCH FOUR COPIES) <br />LOT BLOCN OF <br />E5S . . <br />� S <br />TYPE OF <br />CLOSET <br />SINK 8 DISP <br />LAUNDRY TRAY <br />CLOTHES WASf <br />URINAL <br />PREVENTERS <br />FNONTSETBAGN I p�pASETBACK <br />USEZONE <br />SUB TOTAL <br />__ __...__..._.. •.� ••�•......�.....�. n� �n�a�n� u o�aulrvUflClVliAl1UN <br />$��1�= <br />SIOE SETOACK <br />LOTAREA I YACMlTSITE <br />❑ YES Ll NO <br />iVPEOfLONST.ILWWA9lE � TYPEOFCONSi�CTW11 <br />s¢eoFo�oc. <br />OGCUPANCYLOAD i <br />REASON FOR SPRINKIEflS <br />APPLICATI( Y ACC. BY <br />NO.OF STORIES <br />FIPE SPflNNLEflS REO'D <br />❑ YES ❑ NO <br />PLANSAPPpOVE�BY <br />BRSEMENT <br />❑ YES ❑ NO <br />IIEIGHT LIM1IATION <br />CITY OF EVERETT <br />LOCA� SALES <br />TAX CODE IS 3105 <br />CONTACT PERSON Rh0 PHONE NO. <br />I HERE�Y CERTIFY THAT I HAVE READ .4ND EXAMINED THIS <br />O,PPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDIVANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH 4VHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE F'ROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC� ION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THf WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW A4D 296200 WAC. <br />SIGNATUHEO�CONTprC�R�IUTHOflIZEDAGENT O�TE <br />9 <br />X �\ . . <br />G UNITS--H.P. <br />SYSTEMS—B. <br />IS—B.T.U. M <br />STOVE <br />FIREPLACE 8 <br />HEAT PUM? <br />GAS PiPING <br />E%HAUST F/ <br />PLAN CHECK NUMBER <br />BUILDI�JG . <br />PLUMBING <br />MECHANICAL <br />OTHER <br />S7ATE BUIL�ING SURCHARGE <br />S7ATEENEF.GYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT $ ./�p2_+ <br />TOiAL FEE $ z � rj' �`i <br />FEE NECEIPTNO. <br />VALUATION FEE <br />—�-- <br />i <br />ss; a-ri <br />