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APPLICATI4N FOR CONSTRU�1r.�ON PERMIT �Ve�P�' <br />TO BE COMPLETED IN INK—PLEASE PRINT (� /) � <br />�f �i <br />Ihe Evergreen W <br />CITV OF <br />everett HEATING SYSTEM: ❑ GAS ELECTRIC ❑_ I <br />BUILDING DEPARTMENT <br />2`5� -8810 <br />JC DEMOLITION COMBINATION �BUILDING �MECHANICAL XPLUMBING SIGN <br />OWNER MAILAODRESS CITY ZIP PHONE <br />�oI,J l. Sc�sr 35r�� G.c,.,..� F\x- E�c,•�+r �t �f�-o� 2 S�t•3S'SS <br />TENRNT MAtL ADDRESS CIN ZIP PHONE <br />APCNITEGiOP0E51GNER MFILADDPE55 GIN Z�P PHONE ' <br />GENERRLCONTRRGTOR MAILAUORE55 LITY 1�P PNONE LICENSE� <br />)p,� '-- r,.,_ 351`� Y3.ioqo�� 4�a�..cr 4frzo� ZS8-433� �LAmc.Sdtloo8 <br />MECMANICALCONTN4CTGR MAILAUDRL55 CITV 1�P PHUNE LICENSEN <br />uN k�.a.. ti — <br />PLUMBINGCONTRAGTOR M�ILADDPE55 CITV 21P PNONE LICENSEt <br />Jr, k r.�... �. <br />LLASS OF WORK `�., <br />%CNEW i-� ADDITION .�. ALTERATION .� REPAIR �uEMOLITION ��. - WOODSTOVE/FRPL INSERT I- , BUILDING RELOCATION <br />�� !��I i/ CONT� PERSON RND PHONE N0. <br />/ `7 <br />DESCRIBE WORK <br />FOOTAGEINYOL <br />,,��... S.r.�l�-TM+ a�r <br />PROPOSED USE OF BWLOING <br />S��- <br />LEGRL DESCNIPTIUN oY vHoren i� <br />�pT bLOCK _ <br />� �G i4r <br />OF <br />O�tl <br />UR ARFLH FOUR GOPIE51 <br />PR0.IECT AOOFE55 n <br />�7 fr / I �..c .a� O l'1�"�— <br />PLUMBING <br />NO. TYPE OF FIXTURE OR Il <br />� Z WATER C!.OSET (TOILET) <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVEN� <br />ROOF DRAINS—RAID <br />SINK ISERVICE—BAF <br />PERMIT S <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETOACN REARSETBA� <br />Zo ' � <br />USEZO �aTAR�� <br />6Zo <br />iYPf Of CON75 AIIOWABLE n'PE f CONSi. ALi11Al <br />Tl'_ � I T/�_ 11 <br />ii <br />INT�NE �Y <br />FIRE SPRNKLERS <br />No <br />PLANS AP� VED �Y <br />� ii <br />1 �-1, (""�to oT N R'v� <br />3'-i 8 -13 3 � <br />I HEREBY CERTIFY THAT I HAVE PEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI'I' DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIQN IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />S�GNATURE OF CONTRACTOR OR AUTHORIZED AGENT ORtE I O^ S� S V <br />X �On e t <br />APPLICANiSCITYBU5INE SUCENSENO.ANDBUSINESSNAME <br />MECMANICAL <br />FEE NO. TYPE OF EOUIPMENT FEE <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />SIOE SETBA�K PLAN CHEC ( NUMBER FEE <br />S 2� 75(0 � <br />vncnrvr sire FEES <br />� v BUILOING <br />OCCOFAII:V NO O�bA[II�NG�F:15 <br />ceou� � PWMBING <br />BnSEMENT MECHANICAL <br />NEIGHT LIM1IITATION ADDITIONAL PLAN CHECK <br />Z OTIIER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUEIS 3705 TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE $ <br />flECEIPT NO. <br />'(� � 70 �//. <br />� <br />i <br />W <br />50 <br />�� <br />