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APPLICATIOrd FOR CONSTRUCT'rON <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRIkT <br />259-8810 <br />I I DEMOLITION i I COMBINATION �( BUILDING i MECNANICAL <br />. a — CIIY--_"— __._11P 1'110P[ <br />OWNEO MRIIADfl11ES5��<J i <br />�-- <br />� � N��,r�vn,���, v�ve �� <br />pr )il'�r2.'A �iVll\J�. � 1__�___—�-'_ ----.__. __.____euon[ <br />TENANT MAIlA�f1RE55 GIY ZIP <br />CTORDE IGNF <br />U� � �, � <br />ICONTflAGTOR <br />� I-1;11 C <br />a� uMeirvc r,o�irnnr,ron <br />AIJDfiFSS <br />. _.._ _ _ —__.__.._ <br />CITY -- "" —" �'""T�f' � PIIOHL <br />�'ERMIT <br />i i PLUMBING <br />�-1�80 <br />everett <br />� <br />I I SIGN <br />,` —' CITV "-- ZII• PIIOIlE IlC[NSE I <br />A1RIL aODRCSS /� I r�� 7n �� v`�S /�, r}�f AI : <br />'��(Si� �'�+t^r��V —J� .i'T��I\l�ri11S� _LlL�LL_ '� �� !Jtt� V <br />� — J �;�ry 21P PIIOIIC I.ICFIlSF.s <br />MAII AODRBSS � <br />. . . _ _ _ . . _ . <br />— "_... __— .. _ ___ _'__ <br />. . ...... ._. . - <br />—_—_ _—_•_-__.._.._.. . . <br />. . - —' .. 1'lIU!IL IIfI.N51.tl <br />r.�nn nunia-ss cnr rv� <br />---- �- --- ----- - � - _ _ .. - <br />; aassorwonK <br />� J�NEW I I AUDITION I I ALTERAIION i i_REPAIH i i DCMOIIiION _' Wn����SiUVE�FHPI WShHf i I BUILDINGflELOCAIION <br />; TENNNTIMPPUVEMENTORIMERIORNEMCDELONIY �ip�t{Y�)Ila�tit tfV' ������AI/�'�����������A��UI'IIOIILtlO <br />� , . . <br />, 1(-G- I� �AC�� _._���i�rd�-__ �� ��_ �1J��— — <br />� CONTPACTPflIGEOFWORK: ______.__—..LM-LW.QL— {=-- <br />- DESGRIBEWOPKANDSOUAPEF(XI�iAGEINVOIV[0 <br />� -�-='-'*I �n�c �� ------��---�---_-- EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />; _-_ — <br />� LEGALOESCRIP ONOFPROPERN�SIIOW�IOEIOWORATfAGI1FOtIRCOPlh51 <br />l0T BLOCN ___ V�' _— .—_._"--.--- <br />"" hn1�� ��f-.�t_.�Z_nl.__�-E=-- <br />_�1n�aQQ,_ ' �,.-� ------ ----- <br />PPO.IECTR/O�DOESS M <br />' ' .�J(.]� 1 li.ii�yli�i� .. }��.�IVI�'�_1 _ <br />l <br />TYPE OF FIXTURE OR ITEM rc� <br />�--r— <br />WATER CLOSET �TOIL CT� . , _ .. _ _ . .._ .. <br />-- ----'_----- ..____.. � <br />BATHTUB _. _---- --i----- <br />___.._ _.___. .--_.___. _ .. .. <br />LAVATORY�WASHBASW) , ________;—. <br />-------- � <br />SHOWER __ -----------�---{---- <br />Kf(CHEN SINK 8 DISP ______ ___-_ --;---- <br />DISHWASHER _ _ _ _____ _ __ -.----�— <br />LAUNORYTRAY ______ __ _.. _.—�-- <br />— —__—_— � <br />CLOTHES WASHER _ ___ .__._._._--..— <br />______.._ � <br />URINAL �� -- <br />— -. -_ <br />_-- _. ._ ___ _.- .' -�. <br />DRINKING FOUNTAIN , _ . . --.;--- - <br />Fl OOR DRAIN ' ��-'� - , _ ... .. -... i. - <br />_. --___.- .. - ' <br />BACKFLOW PREVENTERS_ _ _____ ___ __ __._� -... <br />ROOF <br />SINK ( <br />FIiONT SETBACN <br />use� ` <br />�L- � <br />1VPE (1f CONSi. ALLOWP61! <br />SPRINKIERS <br />SUB TO' <br />PERMII" <br />TOTALF <br />REPRSEiBALK � <br />LOl nFEA _ _ <br />nr�t% �v� <br />IYP[ Oi f,Ot151 ACIIIAI <br />V -.v <br />NO OF SiORIES <br />�'IRE SPHNHI EPS 1I@OD <br />I I YES yC NO <br />PPPIICATIONALC.�Y I �'IAN.'.APPRpyE�13Y <br />r� <br />I 1{ER <br />APPLIG.4TION AND KNOW THE SAME TO 8E TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND OHDINHNCES GOVERNING THIS TYPE OF <br />WOFK WILL BE COh1PLETED WITH WHEThIER SPECIFIED HEREIN OR <br />NOT. THE GH.4NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE FROVISIONS OF ANY <br />OTHER STA1 E Ofl LOCAI. LAW REGULATING CONSTHUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEN OF �I"filS PHOPEHTY TO PERFOHM THE WORK FOR WHIGH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOHS LAW 1827 RCW AND 296.200 WAC. <br />swunwr�Eoi�cuinnnr.ioi+onnun�uia«nacem unre <br />X I) <br />,/��T�,� � _(�.l.�i/`._. _1_-L/ _�C:=— <br />APPIICAtII• t.I1Y1111 IN[SSIICLNSCHO AI:Dp115MEti511A1A[ <br />A,'C--A�HN�LG UNITS-H P. <br />FORSED AIR SVSTEMS- B.T.U. _ M E_A,_ <br />UNIT HC-ATERS-BSU. M __ _ _ <br />CI.OTFIES ORYERS <br />VENTII.ATION fAN ___ <br />� RANGE I100D____ _______ <br />WATERI�IEATER ______ ___. <br />. .. .. . __._ _ _—____ <br />_ . . <br />WOODSTOVE _____ <br />MFTAI. FIREPI ACE 8 CHIMNEY ._ ___ <br />_ --- - - --- - - <br />FIF[PLACE INSERT _ . __ _ <br />I IEAT PIIMP . . . __ <br />... _ _'_' -_ ... _ . <br />6AS PIPING __ __ _ __ _...__-- <br />EXHAUST FAN _.____ <br />__I . . _ —} _-_I —._ I - ---" . . --- . .. <br />a I-_ __...__.1_ -I -_ <br />SI IB TOTAL S <br />---PERti��T $ <br />I'IM1NCIIELKNUTA[3ER FGL <br />SI[lE SEi13A�F: ti� � � � <br />� Ni..�E C/ <br />vacar�r sire FEES <br />I i YES % �N� p�p�.p�NG <br />— - --�- ------- <br />�ucu�nin rnimn�,nwncuun.; -----'- <br />cnwm p�UMBING <br />� � _ <br />OASEIdE�li MECI�IANICAL <br />JL YES I i NO --- -- <br />UTI IEfl <br />IILIGIIISIMIlAll011 _"______" _""_'"_-- <br />1" ��L i� <br />�� _���_ S1pIEBU1LDINGSUHCIIAHGL _ <br />S�ATEENERGYSURCHARGE <br />CITY OF EVERETT PIIBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />_ _—._j— <br />_ __—�__— <br />R <br />