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✓ <br />�:LcJ £--i� <br />APPLeCAT101�FOR CONSTRIDCTlt��B PERMIT �'�<<P« <br />TO BE COMPLETE IN IN PLEASE P INT <br />rhe Evergrcen D K— R � <br />CITV OF <br />everett �- <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOUTION COMBINC,TION <br />(yF/T1�R� ��� � MAILAD I� � �O ' <br />K <br />TENnNT MAILADDRE55 <br />nRCMITECiOB�E5IGNER MAILADDAE55 <br />S�P�T2.Um Dr�l�7r r,G- � <br />�NEqqLCONTRACTOR MAILADDRESS <br />P W IAN!NG CONTRI CTOR <br />CLA�SS OF WORK <br />�✓NEW ._i ADDITION <br />LJNTRACT PRICE OF WOPH <br />DESCRIBE WORK ANU SOUAFE <br />N�► C-�►� � <br />PROPOSED USE UF OUILOING <br />LEGAL CESCRIPTION OF PROPI <br />�or_�_ o�ocK <br />M11�IL AOORE55 <br />HEATING SYSTEM: ❑ GAS <br />✓ BUILDING <br />�iir <br />A�eSE <br />ciTv <br />crtv <br />i=os�z <br />CITV <br />ALTERATION . �'. REPAIR <br />z� �-,,.� _� <br />/ <br />C'YELECTRIC []_ <br />' MECHANICAI_ <br />21P PHONE <br />flmrsN, q8a-90 <br />ZIP � PHONE <br />C� �Pr� SNd!'{, <br />21P � PHONE <br />I 4 l —.9�.��'C' <br />ZIP PHONE <br />ZIP PHONE <br />PLUMBING SIGN <br />9ga.qo s3�2697 <br />LICENSEa �QCGO/.TSISr}N% <br />e <br />DEMOLITION ��:_�. WOODSTOVE/FRPL INSERT �� , BUIl..DING RELOC :TION <br />�C TACT PERSON AND PHONE NO. <br />c 1 er-v�.�l �fisl 3o S'S <br />-�� �o� � _ <br />I HEHEBY CERTIFY THAT I F�AVE READ AND EXAMINED THIS <br />2 'rff L APPLICATION AND KNOW TiiE SAME TO BE TRUE AND CORRECT. ALL <br />LOWORA7TACNFOURCOPIES� PROVISIONS OF LAWS AND ORDIN,INCES GOVERNING THIS TYPE OF <br />SP �TI � WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PER�AIT DOES WOT PRESUMF TO GIVE <br />AUTHOAITY f0 VIOLATE OR CANCEL ?HE PROVISIONS OF ANY <br />-C / OTHER STATE OR LOCAL LAW REGULATI�dG CONSTRUCTION CR 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 />CONTHACTORS LAW 1&�7 RCW AND 296.200 WAC. <br />SIGN4 OFCONTRAGTOROqAUTNORREDAGEN7 DaTE <br />X <br />� � C� APPLICANTS CITV BUSINESS LICENSE NO. AND BUSINESS NAME <br />I. ; YPE OF FIXTURE OR I <br />_ WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />� SHON�ER <br />� KITCHEN SINK & DISP <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINA� <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />19q:IdIYI <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN / REAR S�CK. <br />/ <br />G % <br />USE ZON�'� LO�B�� <br />TVPEOiC@�ISAlLOYlABLE TYPEOFWtlSi.AGNAL <br />v-ti <br />SIZE OF BLD . NO.OF STORIES <br />2036 -h '7 <br />�� J �td <br />V iOR SPRINKlERS <br />BY P�pNSAPPROVED6Y <br />�� <br />FEE NO. TYPE OF EOUi."MENT � FEE <br />�— FVC—A/HNDLGUNITS—H.P. <br />;, FONCED AIR SYSTErnS—B.T.U. M E.� <br />7r.� I c.n, UNIT HEATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLHCE INSERT <br />HEATPUMP <br />GAS PIPING <br />E-XHAUSTFAN <br />SUB TOTAL 8 <br />PERMIT $ <br />TOTAL FEE $ <br />z.�- ?svor <br />SIpESETB�K PLANCHECKNIIMBER FEE <br />g �o/a3s6s� .���, <br />vncnNrsiTE � FEES VALL <br />euaoiNc <br />biA4LY M1OO��WfIIINGWlIiS <br />j90pP2 If PLUMBING <br />J F <br />EMENT MECHANICAL <br />IGH�TUQM�TATION ADDITIONALPLANCHECK <br />"�' <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 Tora� <br />PECEIPT NO. <br />Zd i� V <br />�— <br />�5 9 i n� <br />