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� � <br />H <br />>H[~i� <br />H�� <br />�IN� <br />y <br />Hx <br />O � C <br />H�g <br />�r n <br />L' �� <br />t-� y <br />g� <br />n �� <br />m <br />HO� <br />,..:, <br />APPLICATIOi�I FOR CON:�►TRUCT�ON PERMIT <br />everett <br />No Evergrecn � <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />� 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />i DEMOLITION J COMBINATION BUILDING '-' MECHANICAL PLUMBING SIGN <br />01VNEP MAILAD�RE55 CITY '.iP PMONE <br />I�,JA/lI_l/✓ L��fIFNtO/V 200SPNFI� yi g�'1Z07 �% �%CSZ %� <br />TENANT AIAILADDRE55 GITV 21P PNONE <br />A1RIL AOpRESS <br />21P PHONE <br />GENERR�CONTRRCTOR MAILADDRESS LITY ZIP PHONE LICENSE� <br />� V /�f/ i-/2 — <br />MECNANICALCONTRACTOR MAIIAbDRESS CITV ZIP PMONE UCENSEt <br />PL M�NTRACTOR MRILAOORf55 CITY 21P PHONE IICENSE� <br />CLRSS Oi WORK <br />. 1 NEW I�� ADDITION � ALTERATION <br />TENTNT IMPROVEMENT OR INTjapIOR PEMO�EL ONLY <br />CONTRACTPRICEOF\•lOPK:���%�O O <br />DESGBiBEWOPNANDSW4REF0pTAGEINVOIVED �iS <br />.Dvvlck ro,,ver3�on - �u�' �"�� k�� <br />PROP �EOUSEOF6UIlDING �ON�Py31Gr� <br />LOT BLOCN OF <br />2-i1o5 �inetiuRi .A✓�- <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORVIWASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TO' <br />PERMIT <br />FRONiSE'TBA^CN <br />V ' <br />USE 20yE <br />K Z <br />1YP�ONS�lOW0.8lE <br />SIZE Oi BLDG. <br />2�i3 sF <br />OCCUPANLVLOAD <br />/D <br />RLASONFORSPRMNlENS <br />APPUCATION RCG. BY <br />�m <br />BEARSETOACK� <br />Zs <br />LOTRREA <br />n�ar cor�cruu <br />� � � <br />NO.OFSTOPIES <br />v <br />FIRE SPRNNLERS REO U <br />i� YES �NO <br />PLANSr1P�P E�OY <br />REPAIR <br />� cuy e <br />� 11�11�1��1L <br />�PS �r� <br />�'. I DEMOLITION ��, �. WOODSTOVBFRPL INSERT I: BUILDMG RELOCATION <br />. I CONTACT PEFSON AND PNONE NO. <br />4Al IY�. ��IB� l I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ouRcoaiEs� PqOVISIONS OF LAWS AND OFDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEFi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 18.27 flCW AND 296200 WAC. <br />SIGNAiUPEOFCONTRACTORORAUiHORRE�AGENt DAiE <br />`����Y/ *,��!��Ci���(�T� J <br />APP�CITV BUSINE55 LICENSE NO. AND DUSME55 NAME <br />FEE <br />SIOE SET�ACN <br />5 <br />VACRNT SITE <br />!] YES �O <br />acov.acr xonoxnuncu�n�s <br />LflW� <br />BAS[MENT <br />, YES x No <br />HEIGNT LIMITATION <br />Z6' <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TYPE OF EOUIPMENI <br />NC—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />ME?AL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHALIST FAN <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STA7E F.NERGV SURCHARGE <br />PUBIIC WORNS <br />TOTAL <br />FEE ^ 7S I RECEIP'TNO. <br />Y <br />