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,r;:d. , <br />APPLICATIVN FOi; �:O�WST�iIJCI rON PERMIT <br />Ne Evergreen 2VefE?II <br />QT1' OF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br />DEMOLITION = COMBINATION X BUILDING MECHANICAL XPL�iMBING ' SIGN <br />OWNE (/ All pRE55 �� _ ��� CITY . � G,I /(,�/' '���� PHON� <br />, C Y G L 7 3—�'D�� <br />� a��.; <br />TENANT MAILAD�RES.a —�—`- CITV ZIP PMCNG <br />ARCHITECTOF�ESIGkER MAILADDRESS CIN ZIP PHONE <br />�C <br />kIAIL AODPESS <br />oyrtY ZIP <br />CITY ZIP <br />LiQ€W ❑ ADDITION : � ALTEAATION .. REPAIR '- DEMOLITION <br />TENANTIMPROVENENTORINTERIORREMOOELONLY WSFr �pNLWj, CONTACI <br />CONiRACT PiiICE OF WORN: V II � 7� <br />OESCRIBE WOPN AN� SOUARE FOOTAGEINVOIVED / �� <br />LE�iAL �ESLRIPTiON OF PROPF� <br />LOT�_ BLOCN <br />�ILENSF a <br />t <br />-� WOODSTOVFJFRPL INSERT ❑ BUILDING HELOCATION <br />I HEHEBY CERT!FY THAT I HAVE REhO AND EXAMINED THIS <br />/,�'.�/C % APPLICA?iON AND KNOW THE SAM'c TO EE TRUE AND CORRECL ALL <br />LOW ORAITACHf OUR COPIES) PROVISIO�S OF L4WS AND ORDINANCEB GOVERNING THIS TYPE OF <br />oF 1i-L�-�-=X � j�% WORK WILL BE COMPLETED WITH WHETi1ER SPECIFIED HEREIN nR <br />� NOT. THE GRANTING OF A PERA�IT DOES NOT PRESUME iJ GIVE <br />AUTHORITI' TO VIOLATE OR CAtVCEL THE PROVISIONS OF ANY <br />OTHER STATE OFi LOCAL LAW REGI�LAI'ING CONSTRUCTION OR 7HE <br />PERFORhIANCE JF CONSTRUCTION. THAT I APd AUTHORIZED BY THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR NlHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTO .AW 1B2% RCW AND �96.2G0 WAC. <br />SIGNATURE CO AGT:iFORAUTHOFIZ[OAvENT DATE <br />1 1/ \ <br />T�O X. i A/� ./ � i: <br />PROJE /\ /\RX /\ ( �Jl �L�/�J < � ' <br />PLUMBING <br />Nn. TYPE OF FIXTURE OR ITEM <br />� WAT[R CLOSET (TOILET) <br />/ SHOWER <br />KITCHEN SINK 8 DISP <br />� DISHWASHER <br />LAUNDRYTRAY <br />�_ CLGTHES WASHER _ <br />URINAL <br />DRINKING FOUNTP.ItJ <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAH, ETC.) <br />FR01JT SET�CK ', <br />USE�/ <br />✓ <br />iVPE0FL0':Si.AILOWABLE <br />_� <br />SIZE OF BLDG <br />2771 Sf r <br />_�i9 S: <br />OCCUPRNCVLOAD <br />REASON FOF SPRINKLERS <br />qPPLICATION ACC. BV <br />� MECFiANICAL <br />NO. ','YPE OF EOUIPMEMT <br />FVC—A/HNDLG UNIT.G—H.P. <br />� ( FORCED AIR SYSTEMS-8.7.U. M E.A. <br />� IINII'HFATFRS—NTII I�A <br />— �_ VENTILATION FAN <br />! RANGFHOOD <br />� WATER HEATEF <br />—� WOODSTOVE <br />METAL FIREPLA.E & CHIMfJEY <br />� FIREPLACE INSEflT <br />REAROET� � SI� SEi�ACK PLFNCHECKa33�a <br />G <br />�oT nnen vacawr sire FEES <br />�C YES ' NO BUILDING <br />iYPEOFGONSLfLTUAL OLCUCANCY NOOiCWFIIINGOHIiS <br />� GACu� <br />Q,3 PLUMBING <br />NO.Of STORIES 9ASEMENT MECHANICAL <br />x YES ❑ NO <br />FIRESPPNNLERSREO'D HEIGHTLIMITATIqN OTHER <br />I� YES Xi NO �' <br />STA7E BUILDING SI�RCHARGE <br />STATE ENERGV SU�;CHARGE <br />PIANS APPROVEO BY CITY OF EVERETT Pl18LIC WORK$ <br />9� LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FEE I ^ 7S RECEIPTNO. <br />a <br />0 <br />