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� ''... <br />APP�.ICATIC'��J lFOR CONSTRUCT'.JN PERMIT <br />fhe Evergraen <br />CITV OF <br />everett <br />BUILDING DEPAFTME�iT <br />259-BH10 TO BE COMPLETED IN INK—PL�E�A E PRINT <br />❑ DEMOUTION ❑ COMBINATION I J BUILDING 'N'MECHANICAL ❑ PLUMBING <br />d <br />everetf <br />e <br />❑ SIGN <br />OWNER MRILAODRE55 CIiV ZIP P11DNE <br />l�lor�cd �rc.�a�-L�-l~�mcu,t. 2�i� l..an�,v�-i.�J�. �u.e�,o.t-�-`�`�203.� <br />TENMIT MAILA�Of1ESS CIfY ZIP PIIONE , <br />353• z�5�5 <br />pRC1111ECTOROESIGNER MRILAODt1E55 CITY 21P VIIDNE <br />OENER�LCONTPRCTOR MAIL A�DRE55 CIIY ZIP PNONE L'CENSE � <br />M�I� AO�RE55 <br />1�115 • � 2 <br />PLUMOINpCONTf1AC:OR MAII�DOHE55 <br />CLASS OF WOAK <br />CILY <br />a � I��. ►�� <br />CIIY <br />uP <br />amd <br />21P <br />1'IIONG <br />�i2� •N5 <br />PIIONE <br />❑ NEW Cl ADDITION I�iALTERATION CI REPAIR I 7 DEMOLITION I 1 WOO�S?OVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TEN�NT IF:PPOVEMENT Ofl MT�qIOA REMODEnL O,N1I,y CONiACT 1'EIi50N AND PHONE NO. <br />GONTR�f.T PRICE OF V/ORN: `'1 � �' � <br />� DESCRI9E WOFK M!O SOURFE,F.�W^ I�R.G^E IHVOWED <br />�� ��0�'OSE�UI OINO 1 � <br />I LEOFLOESCRIPTIONOFPR�'Litt(5lIUM��ELO� <br />j �or ULOCN oF <br />i <br />i <br />PLUMBIN6 <br />NO. <br />LAUNDRYTRAY <br />CLOTHES WASF <br />UR!IJAL <br />ORINKING FOU1 <br />FLOOR �RAIN <br />BACKFLOW PRI <br />ROOF DRAINS- <br />SINK (SERVICE <br />FPONTSEtBRCK <br />USEZONE <br />I <br />' 1Y1'f pf �O45I. �LLOWdBLE <br />62EOFBlIX3. <br />� OCCUPANCYLOAO <br />PER;AN FON SPRINNLEI <br />SGViY�R. U/J Q��1J�, <br />OERfI SEIBRCK <br />�oranen <br />IYPE Of CONSt. �G111AL <br />NO. OF SIORIES <br />FIRE SPRNNLERS fiEOD <br />❑ YES [J NO <br />APPIICAf10N�CC.OY I PUNSAPPf10YE0BY <br />SIpE SEIBACK <br />VACANT SIIE <br />1�I YES I 1 NO <br />I HEFlEBY CEFTIFY SHAT I HAVE READ AND FXAMINED THIS <br />APPLIC�TION ANO KNOW THE SA.ME TO BE TRUE AND CORRECT. A:l <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF ANY � <br />OTHEF STATE OR LOCAL �.AW REGULATING CONSTRUCTION OR THE <br />PERFORM�NCE OF CONSTRUCTION. TF1AT I AM AUTHORI2ED BY THE <br />OWNFR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 FCW AtJO 296.200 W�C. <br />SIONATUf1EOFCONIMCi0f10RAUT110RIZED�GENT �A7E <br />I�.�� 02�0 3"1 z <br />X sum�k 4nc - � �n <br />APPUGANIS CI7Y UUSINE55 LIGEBSE NO. ANO BUSR:C55 NAME <br />VENTILl�TION FAN <br />RANGEHOOD <br />PLANCHECKNUM0E0 <br />8 <br />eui�oinc <br />acm�u�r xa mmnwxouxns -- <br />���� "I.UMOING <br />BnSEMENi MECIIANICAL <br />U VES ❑ NO <br />f1EIG11fL11AlINION OiHEfl <br />STA1E t1UILDINO SURCHARGE <br />S7ATE 8NEf1GV SURCN4RGE <br />CCYOFEVERETT ruoucwonKs <br />LOCAL SALES <br />7AX CODE IS 3105 *otA� <br />B.T.U. <br />M <br />SUB <br />PERMIT t I <br />TOTALFEE S� <br />FEE �ECEIPTNO. <br />FEE <br />r'" <br />