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�l' <br />APF�LICATIO: FOR CONS�'RUCT� N PERMIT everett ' <br />rheEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � � <br />CITY OF } <br />eVe�e�l HEATINGSYSTEM: OGAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 I <br />_ DEMOLITION � CObIBINATION � BUILDING '_ MECHANICAL � PLUMBING SIGN <br />OWNER MAILADDRESS CITV ZIP PHONE � <br />';�VTO F`��11�� Q550C.•iHTc7 IHO yV 17A`/TUN �T'• ED4'nC��,i�S lvF1. -1i4 - ISi I i <br />TENANT MAILAOORESS CITV ZIP PHONE �. <br />Tnuw�Phs�NT in��• j <br />AFCMITECTOR�ESIGNER h1AILA0DRE55 CITY ZIP PHONE i <br />�VArrt� l.va�'�r� 111 7vr»��.,. �R• ED\•t�Gr�iIS tvFi. 9'F'io2c �774 - C�8 a � <br />GENERAIGONTRACTOR MAILAODRESS CITY 21P PHONE �' `� UCENSEr <br />}� 2vc-• ' cc <br />TIiCGcTvv2ST L.i:6F� 71P^ :�Z 2varc�� J�nl1 wy � rVCf21C WP1. �a ZC", ��.'"C 1 WGI -7'YiC] <br />MLCHANICALLONTRACTOR MAILA�DRESS CITY ZIP PMONE LICEN M <br />PLUMBINGCONiPACTOR MAILAO�RESS CITY ZIP PHONE ULENSEi <br />CLASS OF WOFK <br />� NEW � ADDITION )C ALTERATION <br />CONTFACT PflIGE OF WORK 3� � �' ��% <br />DESCRIBE WOflK AND SOUARE FOOTAGE INVO W ED <br />(EN4N _I yp�Jl�✓� YNCKII� J <br />PROPOSED USE OF BUIL�ING <br />LOT BLOCK <br />.31E: ..�.�: �eV�r�Ti <br />PLUMBING <br />OF <br />r� REPAIR C DEMOLITION ❑ WOODSTOVE/FRPL INSERT <br />ICONTACTPEfl50NANDPHONENO. <br />1nt�iC� iCrc,�r�rr�ti�a- <br />'� t i i � �` «� <br />TYPE OF FIXTURE OR 17_M <br />N'ATER CLUSEi (TOILET) <br />BFTHTUB <br />LAVATORY (WASH BASIN� <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER _L <br />LAUNDRYTRAY � <br />CLOTHES WASHER j � <br />URINAL <br />pRINK14G FOUNTpIN <br />FLOOR DRAIN. <br />BACKFLOV REVENTERS <br />ROOF AINS-RAINLEADERS <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: -,s nn� - <br />FRONT SETBACH REAP SETBACK <br />USEZONE LOTAPEA <br />C- � iZ � <br />1YPEOFCONiS.AILOwABIE 7YPEOFCONSi.ACTUAI <br />V—IH2 ✓—ll/� <br />SIZE OF BLDG. NO.OF STOqIES <br />7 5 5Q•FL �_ <br />CUPANCY LOAD FIFE SPflNKLERS REO'D <br />fOF <br />INiAKE BY <br />BY <br />�-'. BUILDING RELCCATION <br />�l�-�Z�c�'I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCFS GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Ofi <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNRTUREOFCONTRACT ORAUTHOHREDAGENT DATE 3/� /� I <br />X������ <br />, � <br />APPLICANT$ CITY BUSINESS LICENSE NO. ANO BIISINE55 NAME <br />FEE NO. TYPE OF E�UIPMENT FEE <br />� A/�A/HNDLG UNITS-H.P. <br />/ ; FORCED AIR SYSTEMS-B.T.U. M E.A. <br />� UNITHEATERS-B.TU. A4 / <br />/ ' CLOTHES DRYERS <br />' VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE & CHIM Y <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTF ' <br />� <br />� <br />� <br />g ' SUB TOTAL S <br />5 PERMIT S <br />S . TOTAL FEE $ <br />SIDE SETBACN <br />� <br />VAGANT SITE <br />acuvexer �uoorrnrewneunrts <br />400UP <br />�� a� 1 <br />BASE IENT <br />HEIGHT IIIAITATqN <br />CITY �F EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUN CHECK NUMBER <br />q � /�G S�.P' <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PIAN CHECK <br />OTHER <br />STATE BUILDING SUFCNARGE <br />PUBUC WORKS <br />TOTAL <br />E RECEIPTNO. <br />�.��. 9 � °/S7� L <br />VALUATION FEE <br />3� �� s �r3 � <br />i <br />� <br />i <br />�,cl� � <br />