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� APPLICA°TIO E�R CONSTRUCT�M� PERMIT everecc <br /> , TO BE COMPLETED IN INK—PLEASE PRINT � . <br /> � the Evergreen �� <br /> CITY OF <br /> ! everett NEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> � BUILDING DEPARTMENT <br /> � 259•8810 f�] PLUMBING ❑ SIGN <br /> � ❑ DEMOLITION I l COMBINATION i I BUILDING I i-MECHANICAL <br /> , MAI�AOORE55 CITV 21P ` PHONE <br /> /OpWNIE'R , I �� /� � _j B�)� ��Lt� O� <br /> � l e�� 1lc�{ ATd� n Snn 1�{�� F�MT faw �tc�d' � — <br /> � MRIlA00RE55 CITY ZP PHONE <br /> TENANT <br /> � PHONE <br /> 'f pRLHITELT OR OESIGNER MFII R�ORE55 <br /> CITV ZIP <br /> GENERPLCONTRACTOR MAILAOORESS <br /> CITV 21P PNONE LIGENSE• <br /> � CItV zir 3,y,cr��/ PIIONE �IGENSEM <br /> � MECHANIGO.LGONiRRC10N MAILADORESS <br /> ��u ��„� , /d�?^ Il2 5� S'vf' �rrnWil c�ti ��� �ro� v.asµ,n� �_�S_�B <br /> PLIIMB'NGGONTRACTOR MAILADOFE55 <br /> CITV ZIP PHONE UCENSE� <br /> I <br /> �q CIA55OP WORK � <br /> O NEW 'Cl ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT f 1 BUILDING RELOCATION <br /> CONTFCTPERSONANDPHONEVO. <br /> ��� CONTFACT PRqICEqOF WOpRK pp C.� <br /> � R1�1QllNDS'\ VQ.\ TA�I �QCO � �iQJ QI • <br /> .� PROPOSEDUSEOFBUIIDING ^ I HEREBV CERTIFY THAT I HAVE READ AND EXANiINED THIS <br /> ', � � Ll APPLICATION AND KNOW THE SAME TO BE TFUE ANJ CORRECT.ALl <br /> �� �� PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOfFPOPEFiY�5NOW1lUELOWORATTACNfOURC(1PIE51 y,rpRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> .�� �oT e�ocN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ' OTHcR STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ; PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY 70 PERFORM THE WORK FOR WHICH <br /> � APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> �� � CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> •� SIGNAiUREOfCO��iP/CTOROR�UiN EDAGEN7 O�TE <br /> � y <br /> � A � <br /> j — __ <br /> j PRQIECTP�"��I � � APP�ICANTSCI �USINESSLICENSENO.F BUSMESSNRME <br /> ! <br /> � PLUMBING MECHANICAL <br /> t <br /> S Np, TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> j WATER CLOSET(TOILET) � NC—NHNDI_G UNITS—H.P. ' <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> '� LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> � CLOTHES DRYERS ' <br /> � SHOWEF � <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> IAUN�RYTRAY � WATER HEATER <br /> �' CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE&CHIMNEY � <br /> '� UFINAL �IREPLACE INSERT � <br /> �� DRINKING FOUNTAIN ' � <br /> � FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOWPI�•�VENTERS i GASPIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> ��� SINK(SERVICE—BAR,ETC.) � <br /> i <br /> ; <br /> � <br /> i �—�' <br /> i <br /> SU8 TOTAL S ; SUB TOTAL $ G— �'"V <br /> ,� PERMIT $ � PERMIT 5 — � <br /> "� — TOTALFEE 5 U 'OG <br /> �. TOTALFEE 5 ,. <br /> FOR OFFICE USE ANLY: a¢ceiarNo. <br /> � FRONTSETB/CK OEARSET6ACK SIDESE7BAC:< PLANCHEGNNUMOER <br /> FEE <br /> �aTpqEp VAClNTSITE FEES VALURTION FEE <br /> USE20NE � <br /> i BUILDING � <br /> et[ur�Ntv NO W mvttl�MGuni15 � <br /> ' 7VPEOFGON75.AllOWAOIE iYPEOiLONS1.ACtOPL �p�p � <br /> PLUMOING �_ <br /> SREOFBL�G. NO.OFS70FIE5 BASEMENT MECHANICAL <br /> J � � U <br /> ' AODITIONAL PLAN CIiECK ' <br /> OCCUPNNCVLOAU FIRESPRNNLERSREOD HEIGHTLIMITATION i <br /> I � <br /> OTHER � <br /> ' REASON FOF SPRiNRLERS � <br /> STATE BUILDING SURCHARGE ' <br /> � <br /> I CITY OF EVERETT PUBLIC WORKS � <br /> INiAKEG/ PLANSAPPROVEDBY <br /> � . LOCAL SALES <br /> TAX COUE IS 3105 TOTAL 3lJ j D(, <br />