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I <br /> APPLICATII'-,N FOR CONSTRUC'Y'�ON PERMIT <br /> everett <br /> 1he Evergrebn � . <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION CI BUILDING I I MECHANICAL LI PLUMBING O SIGN <br /> OWNER MAILA�DNE55 n CI1Y ZIP PMONE <br /> �• -._�i��; 5 � t,�S' Lo�8�d2�J G J i 9�a o r ^ <br /> TENANi• MAILA�DRESS CITY ZIP PHONE <br /> 3AM�. <br /> ARCHITECTORUESIGNER MFILAD�RE55 CITY ZIP PIIONE <br /> GEN PALCONTRACTOR lAAI A�OFE 5 CITV 21P PNONE LICENSEa �s. <br /> I�ol2TN 5da,�� Dt�Rs /yyoNS �t F o 3- ' a ,7��s � k',�! <br /> MECHANICALCONTRRCiOR MNILADORE55 1 �.� <br /> iTY Z�p PNONE LICENSEq <br /> PLUMBINOCONTHACTOF MRIL�ODRE55 CITV ZIP PIIONE LICFNSE� <br /> CLASS OF WORK <br /> ❑ NEW ❑ ADDITION I�I ALTERATION �C REPAIR I I DEMOLITION I I WOODSTOVEIFRPL INSERT [ I BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTENIOR FE/M'O�pEL ONLV CrONinCT PEIiSON ANND PHONE,rNO. <br /> CONTRFCTPFlICEOFWOHN• �] / L � ' /�{�1 �ry��v� J Gb3- aS 1� <br /> DESCflIBE WO�iK AND SOUARE F TAGE INVOLVEq `SO� � <br /> Qtm� cbu.J� 'tronl R�111 R Eb�uo� L <br /> PROPOSED SEOF IILDING '�-- I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Q�C '��.� .7,�� � �,(Z' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �Q� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALOESCRIPTIONOFPROPEFTVISIIOWNBELOWOPA7IFCHFOUflCOP1E51 yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi I.� � e�ocH 43 4 oF L�l� �� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> L „� � � ^ �Q � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOflMANCE 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 296200 WAC. <br /> SIGNATUBEOFGONTRACTOROR�UiHOHREDAGENT D� <br /> X �.u�1� � ' <br /> PRQIECT ADDPESS �PP�ICFNTS CITY BlI51NE55 LICENSE NO.AND BUSINESS NAME <br /> a� i a 5 �aw� s3�4R <br /> PLUMBING MECHANICAL ' <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT F�_ <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESDRYERS � <br /> i(ITCHEN SINK 8 DISP i VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � _ <br /> LAUNDRYTRAY ; WATERHEATER <br /> CLOTHES WASHER i WOOD STOVE ' <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING fOUNTAIN � FIREPLACE INSEFT <br /> � <br /> FLOOR DRAIN � HEAT PUMP <br /> i <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAIN�EADERS � EXHAUST FAN ' <br /> i <br /> � SINK(SERVICE—BAR,ETCJ I � <br /> i <br /> � ---�— <br /> _ � <br /> � <br /> _ <br /> � <br /> � <br /> � ' <br /> � SUB TOTAL $ ' <br /> SUB TOTAI $ _�_ � <br /> PEflMIT $ � P[RMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FRONT SETBRCN REAR SETBACN SIDE SEIB�CK PIAN GHECN NUh10EP FEE RECEIPT NO. <br /> usezot+e IOTAREA VAC�NTSITE FEES VALUATION FEE T_ <br /> I 1 YES f 1 NO BUILDING �- '— <br /> TYPEOfLON57.PLLOWABLE 7YPEOFLONST.FCNAL aai'uitr HoOfOw¢uMGUNnS � <br /> GnWP pLUMBING <br /> � <br /> I <br /> SI2EOFBLDCa. NO.OFSTORIES OASEMENT MECHANICAL � <br /> I I YES I I NO ; <br /> OCCUPANCVLOAD FIRESPiiNKLERSRE00 HEIGHTLIMITATION <br /> OTHER � <br /> f I YES I I NO STATE BUILOING SUFiCHARGE '� �.f� <br /> �— <br /> flEA50N FOR SPPINKLERS � ! <br /> STATE ENEFiGV SUFiCHARGE � <br /> i <br /> APPLICATIONACC.OY PLANSAPPROVE v CITY OF EVERETT PUBLIC WORKS i ; <br /> LOCAL SALES � � <br /> TAX CODE IS 3105 TOTA� ' , <br /> , <br /> . . .. . __.__ ... ...:; ' .__�.. �. .... . <br /> .. -. 1 . . . .. __._. . . . .. . . . <br /> ��+�..��1' <br /> ..�...�.. .. .._. ....... . .. .. ` .. �' ' <br />