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,- <br />� <br />APPLICATI4� FOR CONSTRUC4rdN PERMIT <br />everett <br />fhe Everpreen <br />CIN OF � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION 1�( COMBINATION y�i BUILDING xMECHANICAL �?CPLUMBING ❑ SIGN <br />OWNER MAILpDORESS CITV ZIP PHONE <br />Wksr SeuAm �usrnuc�rr.�ti/ �Tiuc. P �, Qox ?6�S �u�� cdq., 98�03 <br />TENANT MRILAODRE55 CITY 21P PHONE <br />�PLHITECTONDESIGNEfl MAILAD�RESS C17Y 21P PNONE <br />Cnt/lau.�. _/�rn� Ao�anr.�rc l��c N,6. QauEUNa R1Ve. S�t- <br />MAIL r1DONE55 CITY ZIP PHONE LICENSE � <br />.. `/ .. /i n . __'�. „_"� �...w .. <br />MECHANICALCONTP�CTOR M�ILAODRESS QTY 21P PIIONE ' LICENSE� <br />�� <br />PLUMBING CONTqAGTlO' MAIL ADDflESS CITY 21P PIIONE IILENSE � <br />CUSS OF WOflK <br />❑ NEW � ADD�TION <br />TEN�NT IYPpOVEMENT OR INTEF <br />CONTRACT PRICE OF WORK: <br />VORN pND SOUARE FOOTAGE <br />00/�l— A-�Oic <br />USE OF BUIL��� <br />ALTERATION 1] REPAIR C) DEMOLITION I.1 WOODSTOVE/FRPL INSERT ❑ BUILDING FELOCATION <br />LEGAI. DESCHIPTION OF oROPEflTV (SHONM BELOI <br />L07�� BLOGK Of <br />BATHTUB <br />LAVATORY�WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />TRAY <br />PREVENTERS <br />iNTACT?EPSON �NO PIIONE NO. <br />._T�oE� i�'�tGsAGe� 3S3-3SS"'2 oF <br />33`7 - 0�2'7 H�^ <br />I - �!'ti:$. -s�3 s- peb <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND Y.NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PAOVISIONS OF LAWS AND ORDINANCES GUVEFNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM P.UTHORI2ED BY THE <br />OWNER OF THIS PROFERTY TO PERFOFiM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO RACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Sl.i REOFCONTqACTOROR UTHOfl12E0AGENT DATE <br />X R. �3�3�� <br />Ur , c.� !9 �sr So4NA CA�snt, TNc_ <br />APPLICAN75 CITY BlI51NE5S LIGENSE NO. AND BUSINE55 NA1AE <br />FEE I NO. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSER7 <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />TOTALFEE $ <br />��� flEAflS�ETBnGK SI�ESETpACK PLANCH CKNIIMBER <br />Y I � O�o`� S'1 G« `%�a ya � <br />!t ^ 1 <br />�Pf OF CONS�AB' ^l i . <br />r�+ <br />SIZE OF BLDG. <br />acu�� <br />� <br />REASON FOfl SPRINNLERS <br />APPIICATION ACC. BY <br />TVPE OFCOfI� <br />NO, OF STORIES 4 � <br />� <br />FIRE SPRHNlERS REO'0 <br />U YES $� NO <br />� , <br />PLRlS r1PPflOVED �Y <br />VPCANTSITE ' hEt, <br />CI YES . NO BUILDING <br />OLCUYNICY NO OIbM:IINGJN115 <br />�p PLUMBING <br />eaSEMENT ME�4ANICAL <br />YYES ❑ NO <br />HEIGHTLIMI�TION�� OTHER <br />D STATEBUILDINGSURCHARGE <br />STA�fE ENERGV SUfiCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCALSALES <br />, 1AX �pUE IS 3105 TOTAL , <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE RECCIP�NO. <br />Sb6. 6 6' 3'i3 <br />0 <br />N <br />.� � �%ll.� .�F., ` _ ` J � _ - � U i <br />