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_ .-. <br />APPLICATIt,�nl F0R CONSTRUCI.ON PERMIT evereit <br />theEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />25H-8810 <br />' DEMOLITION iu COMBINATION � BUI:.DING '_ MECHANICAL ❑ PWMBING ❑ SIGN <br />MAIIADDRE$S ^� CIN ZIP PHO/N�Ep� I_ J (/ , /1 <br />NER (L . (� _._. 1 /. _. _ �,Lh �,�./ i 7/1Q � ..._... �.�nni� `-1 N 1 �/1 �YJ / �o�"i <br />TENANr- I MAILAD�RESS ""' "' <br />J <br />AF'.4 lC'. JR DESIGNER MAIL AODRE55 LITV ZIP PHONE <br />��n. Zip PHONE LICENSE Y <br />GENE InLGOr::RACTOR MAILAODRE55 <br />5� CITY ZIP PMONE LICENSEO <br />MECHANICALGONTRACTOR MAILA�DRE55 <br />PLUMBINGCONTRACTOR MAILADDNE55 <br />CITY 21P PMONE �ICENSE R <br />GLASS Of- WORK <br />❑ NEW �i ADDITION i-! ALTERATION ;] REPAIR <br />����� <br />CONTFACT PRILE OF WORK <br />OESCRI� B�NDSOUAREFOOTAGEINVOLVEO <br />� 2�XZ5 �bu�(- � lbNO S�� <br />PROPOSED USE OF BUIL�ING <br />LEGn� 11ESCHIPTION OF PROPEHTV (SHOWN BELOW OR InTTAGM �uu <br />LOT BLOCK OF �4ti:. SE <br />�� �N� '��Y�i� 75J`�� !% �fc�C� 38 <br />/ • <br />NO. TVPE OF <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 8 DI; <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAIN:. <br />FOR OFFICE USE ONLY: <br />PRONTSETBACN REARSETBACK <br />LOT AREA <br />SIZE <br />OCWPANCYLOA� � FIPE <br />REASON <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />� SIDE <br />py �,��N57.PPROVEDBV <br />DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING FF_LOCATION <br />ONTACi PERSON AND PHONE NO. <br />I` � , _ , �,,.�ti� �i�u_��in <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TiiUE AND CORRECT. ALL <br />— PROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TYPE OF <br />�� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GLVF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />I���OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WhICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 1827 RCW AND 29E200 WAC. <br />SIGNATUREOFCONTP!CTOROHAUTHORIZCDAGENT DATE /,a-//3I%/ <br />TS CITV BUSINESS{ILEN�E NO. AND BUSINE55 NAME V yJ/ _ <br />„A,C/ <br />4NICAL — <br />TYPE OF EOUIPMENT FEE <br />AIC—A/HNDLG UNITS—H.P. <br />FORCED AIF SYSTEMS—B.T.U. M E.A. ' __ <br />UNIT HEATERS—B.T.U. M _� <br />CLOTHES DRYERS ' <br />VENTILATION FAN ___� <br />_.....�..,..... � <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST ;=AN <br />0 7 S' <br />VACAN? SITE r«� <br />BUILDING <br />OCLpPAY[V NOOiUJIFIUNGUNIiS <br />enouv PLUMBING <br />BnSEn�Ee7 MECHANICAL <br />HEIUHTUMiTATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILOING SURCHAP.GE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 rora� <br />$ <br />$ <br />S <br />