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n r� <br /> APPLICATION FOR CONSTRUCTION PERMIT everett <br /> fho Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � ' <br /> CITY OF <br /> everett HEATING SYSTEM: ❑GAS f]ELECTRIC U_. <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i I DEMOLITION I I COMBINATION I I BUILDING 1 I MECHANICAL �PLUMBING ❑ SIGN <br /> pyMEq MAR�ODRESS CIfY ZIP PIIONE <br /> L'iJL�iXll ��s�oe �.����.%, >�vi �t,ra��L E��,..r�`9Fwi �.SFt 5 za Z <br /> 7ENRNT MA �ODRESS �—I:ITY 21P PHONE <br /> ARCNITECTOROESIGNER MAILAOORESS CITY 21P PlIONE <br /> 6ENEHQCONTfl�CTOR AUILADDRESS CIiY ZIP PHONE LIGENSE� <br /> � MEC �NICAI.GONTP�CTOR M�I1110DRE55 GITY 21P PHONE LICENSE/ <br /> �v�-s ���3iv�, 1���3r�ii�� 7 L�sr�u�<�S %YL��� 33y�jo9 JarsP�t��3s��. i <br /> nuMex+oca+mecron MA ADDOESS dTY ZIP PFIONE UCENSE/ <br /> / 1 � � [ l � 1 ! f !/ / / <br /> CLI15S OF V/ORK <br /> I I NEW I J ADDITION U ALTERATION I. I REPAIR I.I DEMOLITION C I WOODSTOVFJFRPL IN.,ERT ❑ BUILDING RELOCATION <br /> � CONT�CT PERSON AND PlIONE N0. <br /> i CONTR�CT PRICE OF WOiiK <br /> DEC.CRIBE WO{iK ANO SOUARE FOOT�OE INVOIVED <br /> ; v EDUSEWBWLDI I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> 4 , APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> LE(UL D SCHIPT 011 OF PROPERTY(SIIOVRI BEIOW OR 11T1�CN FWl1 COPIES) PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> i �oT e�ocK oF NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> y AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL UW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.iHAT I AM AUTHORIZEU BY THE <br /> � OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br /> ` APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> SqN�TU1IEOFCONTP�CTOROR�U1N0i11ZEDMENT WTE <br /> I X � ` , /� / <br /> I �3T2 E55 ���� <br /> �P ITS piY BUSINESS LIGENSE NO.AND BUSINE55 N <br /> ; PLUMBINO MECNANICAL <br /> qp, TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOIMPMENT FEE <br /> j WATER CLOSET(TOILEn O ' — A!C—MiNDL6 UNITS—H.P. � <br /> 1 BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> j LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> � SHOWER ' CLOTHES DRYERS � <br /> I KITCHEN SINK 8 DISP � � — VENTILATION FAN ; <br /> � DISHWASHER � RANGE HOOD � <br /> ' LAUNDRV TRAY ; WATER HEATER ' <br /> � CLOTHESWASHER � WOODSTOVE � <br /> � <br /> � URINAL ' METAL FIREPUCE 6 CHIMNEY � <br /> � DRINKIN(i FOUNTAIN � FIREPLACE INSERT ; <br /> ` FLOOR DRAIN � HEAT PUMP � � <br /> � BACKFLOW PREVENTERS � GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � � <br /> � � <br /> � i <br /> � � <br /> � i <br /> : SUB TOTAL S f � � SUB TOTAL S �_ <br /> PERMIT E � PERMIT S � <br /> � TOTALFEE S { '� TOTALFEE S � � <br /> FOR OFFICE USE ONLY: � 'i <br /> FRONTSETB�CK RE�RSETBACk SIDESE78ACK PI/JIGHECKNUMBER FEE RECEIPTNO. <br /> USE ZONE LOT�RE� VAC�N7 SItE FEES VALUATION FEE <br /> BUILDIN6 i <br /> IYPEOfLONi$.�LLOWA6lF IYPEOfLON51./iC10�1 o[CUnNtY MIXbMlln01un15 � <br /> GRMP pLUMBING � � <br /> SIZEOPBIOC. NO.OFSTORIES B�SEAIENT MECH�NICAL � <br /> ADDITIONAI.PLAN CHECK � ' u <br /> OGWPANCVLOAD FIPESPRNItLERSREQU HEIGNTLIMItA710N � <br /> I <br /> OTHER � <br /> f1EA50N FOR SPRINNlERS � <br /> STATE BUILDIN6 SUPCHARGE i <br /> INTAI(EBY PLANSAPPROVEOBY CITYOFEYEREIT PUBLICWORKS i � <br /> LOCAL SALES <br /> TAII CODE IS 3105 TOTAL � '� <br />