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� <br />(he Evergreen <br />CIN OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION f_1 BUILDING ��(1 MECHANICAL <br />WNEfl MAILADUflESS CITY ZI PI <br />����y�—�i��,..,1 qvl- /�(c�; �✓f Zsa - <br />TENANiI M�IIA— � A�ESS T CITY ZIP PI <br />�� 1� l� l <br />u <br />❑ PLUMBING <br />everett <br />� <br />❑ SIGN <br />ARGHITECTORUESIGNEN MAILA�OflESS CITY Z�P PHONE <br />GENEMLCONTRACTOR MRILAODRE55 Citt 21P PHONE LICENSEr <br />MECHANICAIGONT ACT'OF I MAILA�OFE55 CITV ZIP PHONE LICENSEI <br />1�•U�• I;la�i.r�N.�.'lt� 311U-I�i�r�� /tvd �UI �1�Lo1 257-S3i� Ney�u% 13") 1�J _ <br />PLUM9INOCONTHACTOF MAILAD�NE55 CITY ZIP PNONE LICFNSE� <br />CUSS OF WORK <br />O(JEW ❑ ADDITION �ALTERATION ❑ FiEPAIR C] DEMOLITION C WOODSTOVE/FRPL INSERT ❑ BUILDING REIOCATION <br />TENANT IMPHOVEMENT OH INTERIOR REMOO,E�101 �V� <br />CONTRACTPRIGEOFWOPK: yV(/ <br />DESCBIBE 1YORNANO SOUAR[ FOO7AGE INV VED <br />�r s r�c� ('�as �W 1 � _ <br />PROPOSED USE OF BUILOING/ <br />� �:1.._.�. 1.._..�l.n <br />LEOAL DESCF�PRION OF PN6PERTV (SN(�NN BELOW OR ATTACH FOUfI GOPIES) <br />LOT __ BLOLK OF <br />%i <br />OF <br />SINK 8 DISP <br />FRONT SETBACK <br />USEZONE <br />7YPE Of CONSi. RLLOWABIE <br />SRE OF BLW. <br />OGGUPANCYLO�D <br />REASON FOR SPRINKtERS <br />APPLICRTION ACC. BY <br />PREVENTERS <br />CONTACT PERSON AND PMONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUe AND CORRECT. hLL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEf; SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUPAE TO GIVE <br />AUTHORITY TO VIOLAT[ OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF TH!S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br />SIGNA7l1RE0FCONTPACTOFlORAUTHORIZEDAGENT OATE <br />X �' / � �� �—�, � <br />APPLI�ANTS CITV 9USINESS lIC NO. AllO DOS�IIESS NAME <br />MECHANICAL <br />NO. TYPE OF E�UIPMENI <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <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 CIiIMNEV <br />FIREPLACE INSERT <br />HEAT PUh1P <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ � '� �o <br />PERMIT $ � PER <br />TOTAL FEE $ ' T�T� <br />REFRSETBRCK SI�ESETBACK PLANCHECKNUMBER FE8 <br />LOTAREA VACANTSITE FEES VALI <br />❑ YES ❑ NO BUILUING . <br />7YPEOFCONST.ACtUAL occurxxtt noolrtn'FWxcuuns - <br />�p�v pLUMBING <br />NO.OFSTOPIES BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />FIflESPRNRLERSPEOD HEIGHTLIMIT4TION OTHER <br />❑ YES ❑ NO STATE BUILOING SURCHARGE <br />S7ATEENERGYSURCHARGE <br />PlANS�PPiiOVEDBY CITYOFEVERETT PUOLICWORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />E.A. <br />ITAL $ /J <br />f $ / <br />FEE $ �t <br />RECEIPT N0. <br />