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A�P�.ICLiT1.rN FOR CONSTIr�I�C'� ��N PERMIT <br />the Evergreen <br />CITY OF <br />��erett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />- DEMOLITION -1 COMBINATION =' BUILDING � M[CHANIGAL <br />OWNER MAILAO�RE55 � CITV 21F _` PI <br />/-1 I r�� � � ,k� .�-�i�/`YF / �/ /� �-i'1 � �%l�. � /�F! L� � ��7 /' � <br />, MAILADDRESS <br />lAAIL AD�RE55 <br />MAIL ADDRE55 <br />MECHANIGALCONTRACTOR <br />LITV <br />ciTr <br />CITV <br />CITY <br />PLUMBING <br />ZIP PHONE <br />21P PHONE LICENSE< <br />ZIP PHONE LICENSE u <br />,���;�9 �y <br />ZIP PMONE LICENSE tl <br />everett <br />� <br />SIGN <br />CLASS OF WORN <br />. IJEW G ADDITION ..! ALTERATION .� REPAIR . DEMOLITION J WOODSTOVE/FRPL INoERT C BUILDING RELOCATION <br />TENANTIMPROVEMENTOFINTEPIORFEMODELONLY I CONTACiPERSONAN�PMONENO. <br />CONTRFCT PRICE OF WORI<: <br />DESCRIi1E WORN AND SOUARE FOOTAGE INVCLVED � <br />LEGAL DESGRIPTION OF PROPERTY <br />LOT OLOCN <br />PRO!ECTAODRESS <br />I HEREBY CERTIFY THAT I HAVE READ AND EX:�MINED TH13 <br />APPLICATION AND KNOW 1'HE SAME TO BE TFUE AND CORRECT. ALL <br />LOW ORARACH FOUR LOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK W':L BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THL PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />-- PERFORMANC'c GF CONSTRUCi;ON. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLI�ATION IS MADE AND I COM17PLY WITH THE STATE <br />CONTRAC CiFj6 LAW 1 7 RCW AND 296200 WAC. <br />SIGNnTLW�CONTRACT�A HORREDAGENT DATE <br />TYPE OF FI%TURE OR I?EM <br />SHOWER <br />, KITCHEN SINK 8 DISF <br />DISHWAStiER <br />LAUNDRY TRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF <br />SINK � <br />FFONTSETBACK <br />USEZONE <br />Nrc oF coxsr. nuowne�c <br />SIZE OF BLUG. <br />O:CUP�NCYLOhO <br />REFSON FOF SPRIRKLEflS <br />pPPIICRTION ACC. BY <br />.� � ��'�/ <br />9USINESS LICENSE NO. <br />TYPE OF EOUIPMENT _ <br />AiC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEIdS-6.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENfILATION FAN <br />RANGEHJOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMN=Y <br />FIRFPLACE INSERT <br />SU9TOTAL $ � I— <br />---- � PERYIR S I Y'�r— — <br />TOTAL FEE $ �� —' <br />REARSETBRCN I SIDESETBACN PLANCNECHNIIMBER � <br />LOT4REA VA:ANTSITE FEES <br />❑ YES !� NO BUi�DiNG <br />iYPEOiGONST PCiU<L aCUPextv xo ortwFluxGuwu <br />�AOaP PLUMBING <br />NO.OFSTOPoES 9ASEMENT MECHANICAL <br />.�! YES �.- NO — <br />FIRF 5?RNKlERS R[O'C HEIGHT LIMITATION OTHER <br />f�, YES ._ -� NO 57ATE BUILDING SURCHARGE <br />STATE ENERGY SUP.CHA''GE <br />PIANSFPPROVEDBV CITYCFEVEFETT PJBLICWORKS <br />LOCAL SALC•S <br />TAR CODE IS 3105 IOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FFE RECEIPTNO. <br />a <br />