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,�_ ���-f- <br /> � APPLICATII,N FOR CONSTRUCI .ON PERMIT <br /> everett <br /> rhe Evergreen � <br /> UTY OF <br /> � �y everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> x - <br /> F�� DEMOUTION COM8INATION x BUILDING MECHANICAL PLUMBING SIGN <br /> F] �-I OWNEH AUILRDDFE55 CITY 2iP PNCNE <br /> '� � � 3 IS� Z92� /� d'/ t,G �L03 3f3-s y.�'i <br /> H".Il �01110.5 �M (ADDRE55 r7„n",e� � ci� � zn� PH�NE <br /> �M� TENRNT <br /> Hy <br /> �i ARCHITECTOROESIGNEfl M1IAILAODRESS CITY LIP PNONE <br /> Q� � GENER/.LCONTRACTOR MAILAD�RESS Cltt 21P PNONE LICENSER <br /> � e�a g WoopY's ;�Ci3Y6r�D�l J�z�, �G���/1/ C �/�inafon �QZ23 <0'S2-721J3 Geb-nD-YG-�73/IlA <br /> �r n hl[CHANIGALGONTRACTOR MRILADDRE55 CITV ZIP PNONE 4CENSE� <br /> 1 <br /> .�.� y�r PLUMBINGCONTiACTOR M1�AILRDORESr CI7Y 21P PMONE LICENSE� <br /> Ny <br /> y <br /> �y CLASSOFWORN <br /> n�y � NEW xADDIT10N L� ALTERATION REPAIR _� DEMOLITION � '� WOODSTOVE/FRPL INSERT . '�. BIIILDING RELOCATION <br /> � TENANTIMPROVEMENiORINTEP10RREh100ELONLY / o CONtACTPEP50NANDPNONENO. <br /> �H CA WNTflRCTPRILEOF140RN: � ^ S�„ • <br /> y�y �ESCRIBE WOIiNANp50UARE FOOTAGE INVOLVEO <br /> 4DcuER RcioR ?58'y�� UFYc'7 FcrDR .31 Z Sc �'f� <br /> PPOPOSEDUSEOF9UILDING I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> �,GCvi?.k F�A7R ST�XAbr UR��/Z FLOOR I�CL�RM/7 APPLICATION AND KNOW THE SAME TO BE TRUE AND MRRECT.ALL <br /> l[GA�DESCRIPTIONOP PPOPERTY�SHON iBELOW ORATTACNFOURCOPiES) PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS NPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> �ot etocK oF NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEP STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRJPEHTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNA7UR[OFCONTRACTORORAUTMORiZEDAGENT �RTE <br /> PRDJECTADDRE55 � �` � <br /> � • IC NTS CITY BUSiN[55l�CENSE .ANp B i 5 Y�ME <br /> � � .� a � �-�.-G., � <br /> ' ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE QF EOUIPMENT FEE <br /> '�1 WATER CLOSET(TOILET) A/C—A�HNDI.G UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH f3ASIN) UNIT HEATERS—B.T.U. M <br /> '�' SHOWER CLOTHES DRYERS <br /> '�1 KITCHEN SINK 8 DISP _ VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> 1 ' LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHEii � WOOD STOVE <br /> � � METAL FIREPL�CE 8 CHIMNEY ; <br /> URINAL <br /> �' DRINKING FOUNTAIN i FIREPLACEINSEflT 1 <br /> FLOOR DRAIN HEAT PUMP <br /> OACKFLOW PREV TERS i GAS PIPING � <br /> 1 ROOF DRAINS AINLEADERS � ExHAUST FAN <br /> ' SINK(SEfl E—BAR,ETC.) <br /> 1 <br /> �' SUB TOTAL 5 SUB'fOTAL S <br /> _. . PERMIT S PERMIT S <br /> TOTAL FEE 5 ' TOTAL FEE S ' <br /> FPONTSETBACN HERRSETOAGK SIOESETUACN PLPNCHECNNUMAER PEE RECEIPTNO. <br /> ZC� � �O� S � U � �/ /7 n o 33 .7 SI/ <br /> 115EZONE lOTARER VACANTSITE FEES VALUATION FEE <br /> (t I Q �((J 5.�. :.i YES 5C NO BUILDING �/6 j� <br /> iVPEC�CONSi.AIIOWABLE 1VPEOiCONSi.AC111A1 acuPe�d uOdbMLLi4Guni15 <br /> �P0°P ' PLUNBING <br /> -u - ; <br /> SREOFBLDG. NO.OFSTORIES OASEMENi MECHANICAL � <br /> 5 Z . .'. YES X NO <br /> OCGUPANGY LOAD iIRE SPRNKlERS REOD HEiGNT LIRIITAT�ON OTHER <br /> e ` f � <br /> ' : YES �C NO Z a STATE BUILDING SURCHARGE <br /> REASON FOR SPRINNlERS <br /> STATEENEFGVSURCHARGE <br /> arrucnrioNacC.Bv PUN9�PPFOVEOBY CITYOFEVERETT PUOLICWORNS <br /> /r� LOCFL SALES <br /> 7 TAX CODE IS 3705 TOTAL <br />