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� � � � 5I� <br /> APPLICATION FOR CONSTRUCTIONI <br /> PERMIT <br /> Ihe Evergreen �,��,��,�� <br /> CITY Of <br /> everett e <br /> BUILDItJG DEPARTMENT <br /> 259-88�0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> NEP MAILAODRE55 GIiY ZIP PNONE <br /> �n MGrrl�^l� / 32�'� l�rnl�r�arl �,�2 �'ff�t f ��2U/ 25�-/9/CQ <br /> TENANT MRILP�DFESS CIiY ZIP PHONE <br /> ARGNITECTORDESIGNER MRILA�DRE55 LIIY ZIP PHONE <br /> GENERALCONTRRCTOP MAILADDRE55 CITV ZIP PHONE 4CEHSE• <br /> M �MRNIGICONTRTC OR MRILRODRESS GTY ZIP PNONE LICENSE• <br /> �Ct,L�r,w 6��,!-���1a� .�-0 21�D5 Mc(�,� �,� � L�ir�.l �2a1 259�5�F� V�Cc�I��- <br /> PLIIMBINGL RF�T09 MAILADOflE55 CITV 21P PMONE 4CENSE• <br /> GLASSOF WOPN <br /> ❑ NEW ❑ AD�ITION ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FflPL INSERT ❑ BUILDING RELOCATION <br /> TENANTIMPROVEMENTORINTEFIOR EMODELONLY CONTAGTPERSONANOPMONENO. <br /> GONTRhCTPRICEOFWORK /Q�j � <br /> �ESCRIBE WOPK RND SOUARE FOOUGE'INVOWED <br /> ���-Q_��._A (,CJ - �&�2 _ <br /> PaoPoseo u�eu I H EREBY CERTIFY THAT I HAVE RE.".D AND ExAMINED TNIS APPLICATION AND <br /> ��- KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> / 1�-- <br /> LEGRL�ESCRIPTIONUF PPOPERTYISNOWN BELOW ORAifACH FOURCOPIE51 ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPI C'��WITH <br /> W HETH ER SPECI FIED HEREIN OR NOT.THE GRANTING OF e,�cnMIT DOES NOT <br /> PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCE_THE PROVISIONS OF <br /> tor BtocK or ANYOTHERSTATEORLOCALLAWREGULATINGCONST�UCTIONOPTHEPER- <br /> FORMANCE O�CONSTRUCTION.TNAT I AM AUTHORIZEL�BY 7HE OWNER OF <br /> THIS PROPERTYTO PERFORM THE WORK FOR WHICH APh:ICATION IS MADE <br /> AND I COMPLY WIfH THE STATE CONTRACTORS LAW Ib27 RCW AND <br /> 296.200 WAC. <br /> SIGNALUREOFCONtPnLiOROHAUi OR2EDIGENT OAiE � <br /> _ 1 <br /> X, ��� � p�,�G� <br /> ECI�DDRE55 �p � pNTSCITY6USIN SSV. .ENSENO.ANDBUSINESSN�ME <br /> � ,Q� _LTh't_ /�-- , <br /> PLUMBINO MECHANICAL <br /> Np, TYPE OF FIXTUiIE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSET(TO�LE'f) A/C—A/HNDLGUNITS—H.P. _ <br /> BATHTUB FORCED AIR SVSTEMS—&T.U. EA <br /> LAVATORY�WASHBASIN) UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINKS DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HE.4TER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLGW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAI NLEADERS E7CHAU5T FAN <br /> SI NK(SERVICE—BAR,ETG.) <br /> SUBTOTAL S ' SUBTOTAL $ <br /> PEP.MIT 5 PERMIT S <br /> TOTAL FEE S TOTAL FEE $ <br /> FRONTSETBACN REAFSETBACK SiDESETBRCN PLANCHECKN�M9Efl FEE flECEIPTNO. <br /> USE20NE LOTAREA VRCRNTSITE FEES VALUATION I'EE <br /> ❑VES ❑NO <br /> BUILDING <br /> TYFEOFCANST. OCCUPANCYGROUP NOAF�WEILINGUNRS <br /> FLLOW�BLE/ACTUNL o�UMBING <br /> SIZEOFBLIX:. NOOFSTORIES BSYT OCGLO�D MECHANICAL _ <br /> ❑ N <br /> MEiGHTIIMITAiION OTHER <br /> FIPE SPRINNLERS REOUIREO ❑YES ❑eo STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> pPPL'GAiIONACC.9Y PLANSRPPR.BY PUBLICWORKS <br /> roTa� <br />