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�.t <br />j;�; � j i4�..� <br />APPLICATIOri�i �OR CONSTRUCT:�bN PERMIT <br />!he Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />nwuFa MAILNUDFESS �..� �/'+ �iT� _� .. Z�?.�.._. �__PI <br />everett <br />� <br />❑ PLUMBING ❑ SIGN <br />.�5.�-�nG �'f <br />TENANT M AOOflESS CITY 21P rn�rcc . <br />t <br />AflGHITECTORDE51GNEfl AU�LADDflESS GITY ZIP PMONE � � <br />PLUMBINGCONTRACTOR MAILADDF:455 CITY ZIP PHONE . 4GENSE/ , <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />TENANT IMPROVEMENT OP INTEFIOH flEMOCEL C' �Y <br />CONTMCT PRiCE OF WORK: <br />DESCRIBE WOPK ANO SOUAR'c FOOTAGE vJVOLVED � <br />X pOPO�E O�IL01� �Z� � <br />?� �,� O <br />LEGAL DESCRIPTION OF PROPEflTV (SHOWN BELOW OR ARACN FOUfi COPIES) <br />LOT BLOCK OF <br />NO. TYPE OF FIXTUI <br />NATER CLOSET (TOILE' <br />BATHTUB <br />LAVATORY (WASH BASI <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />ROOF DRAINS—RAINL <br />SINK (SERV� �-E—BAR, <br />il • • <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL IMSERT ❑ BUILDING RELOCATION <br />CONTACT PERSON AND PMONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ApPLICATION AND KIJOIN Th:E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINHNCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH YJHETHER SPEC�FIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br />UTHER 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 FQR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296..^.00 WAC. <br />SIGIIATUREOFCONTRACTOflOflAUTNOflIZEDAGENI DATE <br />�����v""� �o ��—�%a--- <br />pPPLICANTS CITY BUSI4E55 4CENSE NO. AND B1151NESS NAME <br />OR ITEM FEE N0. TYPE OF EOUIPMEN7 <br />� A/C—A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M <br />—� � I I UNIT HEATEFS—B.T.U. M <br />SUB TOTAL S <br />— PERMIT $ _ <br />TOTAL FEE $ <br />FRONTSETBACK HEAFSETBALN SIOESETBRCK <br />USEZONE � IOTAFlEA <br />TYPEOFLONST.AIIOWABLE � ttPEOFCONSLACiIIAL <br />SIZE OF BLIXi. <br />OCCIIPANCY LOAO <br />REASON FOF SPPINNLEPS <br />APPIICFTION ACC. BY <br />NO.OF STORIES <br />FIRE SPflNKlEflS RF.O'D <br />❑ ves ❑ No <br />PLANS APPflOVED 9V <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />IdETAL FIREPIACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />_ SUB <br />_ PER <br />TOTAI FEE $ ' <br />PIAN CMECH NUMBEfl FEE flECEIPT NO. <br />VACANT SITE ��c� <br />C YES ❑ NO BUILDING <br />occuvu¢x xo.avxnuxcuxns <br />�ROUv pLUMBING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />IIEIGMTlIM1TATION OTHER <br />STATE BUILDING SURCHARGE <br />STATEENEFGYSUFCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX COUE IS 31�5 TOTAL <br />� <br />� <br />a <br />d <br />