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.. . . ....�.w.r.. � r <br /> �� _, : <br /> APPLICATId:'J FOR CONSTRUCTri�'' N PERMIT everett i <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> � Ihe Evergreen <br /> CITY OF <br /> everett HEATING SYSTEM: ❑GAS U ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 % <br /> � I DEMOLITION ❑ COMBINATION I , UILDING ❑MEGr�ANICAL�E ❑PLUMBING ❑ SIGN <br /> ��tR MARAOD�IESS ��TY ZIP G,�Z 93�3 I�'r <br /> �G3Ef''r ��-1LU Z i�i S ('uu� FatF�-FfT 9P�Zv/ <br /> tENANT M�RI1DOIlE55 CITV ' ZIP PNONE �r <br /> 11 �� � � � <br /> ' �RC111TEGTOA�SIGNER <br /> M�0_�UDRESS CI1V ZIP P�E il. <br /> � CITY ZIP E IICE�O�C IIOTC <br /> � ,ENER�LCONTN�CTOP MAiLADDRE55 w� � �532I0� �• <br /> N <br /> C�61fO CC�I$��C1J -(�I�UIJ 'P(�•�70xILS7_ f/111�-YSVIl1I= P�E I�cENSEI � <br /> CITY ZIP <br /> � AIECH�NICQ CONT CTOR MAII ADORE55 . , <br /> N�� CITY ZIP PHONE LIGENSE• <br /> PLUMBINOGON7RACTOR MAILAOOFlE55 � <br /> N � <br /> , CLASSOFWORK <br /> ' '�W I I AD N I.I ERATION I I REPAIR I I DEMOIITION I_I WOODSTOVElFRPL INSERT ❑ BUILDIN(3 RELOCATION <br /> �� �y /, CON T PERSON 0 PHONE N0. lZ <br /> i v" /�v 7 �SV•L�(� <br /> LONiMCT PH�LE• ��K � <br /> � pESCRIBE WORK�VID SOUARE fOOTA6E INVC�VED <br /> 7ZOS - ��rxH ��' <br /> � pqpPO5E0U5EOFBUROM6 I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> ;I v���� APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> i lE0l1L DESCR�PTIW70F PR�ERT�ISNOWN BELOW ON ATTACN FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCER 6GVERNINO THIS TYPE OF ' <br /> WORn WILL BE COMPLETED WITH WHE�HER SPECIFIED HEREIN OR <br /> i ioT a�aK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> / - � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> - 1 OTHER STATE OR LOCAL UW REOULATIN6 CONSTRUCTION OR THE <br /> '' PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOHK FOR WHICH <br /> � APPUCATION IS MADE AND I COMPLY WITH THE STATE � <br /> I CONTRACTORS LAW 1827 RCW AND 296.200 WAC• i <br /> i SqN�NREOFCONTMCIORORAUTMMIZEDlU7ENT O�TE , <br /> �� 9''�"� � � <br /> ' x � � <br /> ;, <br /> , <br /> � PIIOJEC�ADORESS APMILANTS CITV BUSME55 LICENSE NO.AND BUSINESS NMAE <br /> , /prs ��n�c , <br /> PLUMBINfi MECHANICAL <br /> • Np, TYPE OF FlXTURE OR REM FEE NO. TVPE OF EGUIPMENT �E <br /> , N�NHNDLG UNITS-H.P. ' <br /> I WATER CLOSET�TOILE� � <br /> � FORCED AIR SYSTEMS-B.T.U. M E.A. , <br /> ' BATHTUB ' <br /> � LAVATORV(WASH BASM) � UNIT HEATERS-B.T.U. M � <br /> � CLOTHES DRYERS ' <br /> , SHOWER , ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � , <br /> RANGE HOOD ' � I <br /> � DISHWASHER � WATER HEATER � � � <br /> � LAUNDRVTRAY ' � , <br /> CLOTHES WASHER � WOOD STOVE ; <br /> � METAL FIREPLACE 8 CHIMNEY ' <br /> � URINAL , ' � <br /> . � FIREPLACE INSERT � <br /> DRINKINCi FOUNTAIN , HEqT PUMP � � <br /> FLOOR DRAIN � pqS PIPING � <br /> � BACKFIOW PREVENTERS ' , � • ' <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> 1 , <br /> � SINK(SERVICE-BAR,ETC.) � _ • � ' � <br /> i <br /> * .� ' i <br /> � <br /> � <br /> i <br /> i <br /> SUB TOTAL S '— SUB TOTAL S ' , � <br /> � PERMIT S ' � <br /> TOTALFEE S '' TOTALFEE S ' � � <br /> i: <br /> FOR OFFICE USE ONLY: rur+cNecKr+ BE� FEE /JO RECEIPTNO. <br /> �� Cp���K REARSETBACK n SIDESE��K / � � <br /> T__ <br /> J � � a EES VALUATON FEE <br /> USEZ E LOT�REA WCANT511E <br /> �_ �.- 9QD0 'f/� 9UILDING f p � 00 ; <br /> (� i <br /> iYPEOiLONiS.ALIOW�BLf 7vPEotcorr5t.�t�uu °�a"�`' ""IX0�"�111N0���S pll'MBI"IG � Od ' <br /> -A/ �N � ' i � ' <br /> SIiE OF BLD6. N�.OF STORIES BASEMENT MECHANICAL , � <br /> � Sf ' '� � : : i �1 . <br /> ADDITIONAL PU1N CHECK � <br /> OCCUPANCY LOAO FIRE SPRNNLERS REOD HEI6NT IIMItAT10N � <br /> No S-� OTHER � . <br /> KA � <br /> ftEA50N FOR SPPINKLERS � � <br /> STATE BUILDING SURCHARGE ' <br /> iM�ME 11V PUNS APPROVEO BV g�TY OF EVERETT PUBUC W�RNS � � <br /> � LOCAL SALES � <br /> TAI(CODE IS 3105 TOTAI �— <br />