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APPLICATIO�� FOR CONSTRUCT JN PERMIT <br />' everett <br />� fhe Evergreen � <br /> „�� GTV OF <br />' �,� everett <br /> p x BUILDING DEPARTMENT TO BE COMPLE�ED IN INK—PLEASE PRINT <br /> Cy H 259-8810 <br /> r�� ' DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> M/�p/�N�PODRE `I./C�ITYn Z�IP� w� PHONE '1 (] ^^ -y-(] r� <br /> K (] 0\YNEP�/� i . � "-4��xLL� �/I9�.(Xl�-f' �d-�(Fl� �V -/�OVI 0�7'�O / <br /> O rT. O TENANT ���1�� `�l �� z v rHor+e <br />� MR�L AODRESS CITY <br /> htl N �i1 <br /> y H PHONE <br /> ARCMiTECTOROESIGNER AIAiLA0DRE55 ��TM Z�P <br /> 1 H <br /> xQ ,� n//yy��11 <br /> Q �...� � GENEFA�N PpG'OR f�i�MAiLAD ESS CIiV ZIP PHONE LiGENSE� <br /> � n Q <br /> �, g <br /> �� Q�! MEGNRNICALCONTRACTOR MAIIPDDRE55 GITV 21P PMONE LiCENSE• <br /> �y �J Z�p PHONE LILENSE t — <br /> � PWMB�NGCONTRPCTOR MAILADDRESS ��T� <br /> HH <br /> N ClASSOF WOfiK <br /> f'7 <br /> O C y � NEW i�� ADDITION ALTERATION � REPAIR DEMOLITION � N'OODSTOVEi�RPL INSERT . BUILDING RFLOCATI N <br /> � L� TENANTIMP1iOVEMlNTOf11NTERiORRE610�EL0 Y CONTACTPERSONAN�GHONENO <br /> �� vov <br /> y fi� CONTRACTPFICEOF\YORN: <br /> y � y DESCRiBE'WO^RHFNDSOUPREFODTPGEINVOLVED <br /> /� <br /> PROPOSEDUSEOFUUILDIN I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> Sr ✓J APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �� �� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEWLDESGPIViIONOFPROPERT�V�5GNO1VN0ELOWORATTRCNFOURCOPiE51 yyORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT oZ�'3a e�xK � oF AU�THORI YRTOTV110LA�TEAOR CANCEL 7HE PROVES ONS OF AINY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTPUCTION OH THE <br /> PEFFORMANCE OF CONSTRUCTION.TH�T I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH �iHE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SiGNnTUPEOFC0Y1RACi0qORAUtnOR¢EDAGENT �AiE <br /> X , <br /> ��1 PRQIECTADDRE55 � A ppp�iC�NTSCITYBUS�NESSIICENSE RN�BUSIN NPM[ <br /> �V%`V <br /> '�' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> FEE <br /> '�1 WATER CLOSET(TOILET) A'C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> I ' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �� <br /> � CLOTHESDRYERS <br /> SHOWER — <br /> ' KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> I LAUNDRY TRAY WATER HEATEF <br /> CLOTHES WASHER WOODSTOVE i <br /> �1 METAL FIREPl.ACE 8 CHIMNEV , <br /> UFINAL <br /> � DRINKING FOUNTAIN FIREPLACE INSERT <br /> 1� FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> 1 ROOF�RAINS—RAINLEADERS EXHAUST FAN <br /> ' SINK(SERVICE—BAR,ETC.) � <br /> i <br /> i <br /> ' ' SUB TOTAL 5 <br /> ' SUB TOTAL S <br /> PERMIT $ PERMIT 5 <br /> � TOTAIFEE S TOTALFEE S <br /> FRONT SEtBAGN REAR SETBACN SIOE SETBNCK <br /> PL�NCHECKNllA1pER iEE FECE�PTNO. <br /> VACANi51TE FEES VALUATION FEE i <br /> USEZCNE ��TpRE� i <br /> ves No BUIIDWG �//�U �o3'GY� <br /> tYPEOFCONR.AIIOWRBIE 1VPEOFCONSCFCiUPI Occvru:cv Noqm.uuMGutinS � <br /> �^°11r pLUMBING �, <br /> SREOFBIW. NO.OFSTORI[S Ba5EM11ENt MECHANICAL <br /> res No <br /> OGCOPANCYLOAO FIRESPRNI(LERSFEO'U HEIGMTUMITATiON <br /> OTHER ' <br /> i_1 YES . NO STATE BUILDING SURCHARGE S D <br /> RERSON FOR SPRINKLERS � <br /> STATEENERGVSURCHARGE , <br /> APPLIG/TION�CC.BY PLRNSAPPROVE�DY CITYOFEVERE7T PU�LICWOIiK$ � <br /> LOCAL SALES � +� � <br /> TAX CDOE IS 3105 TOTAL <br />