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.." i. ..1' . : ��': ':. � . . . � j _ . .. . .. . . . .. . . . . <br />.. . . _. ... .:'... . . . ,:! ..._ �.. . ..��._.._. ...� . . . l{..t'. l.:'>.U.1.'.. <br />�/n��^ . <br />APPLICATIO�I FOR CONSTRUCT:JN PERMIT everett <br />ffw Evergreen TO BE COMPLETED IN INK—PLEASE PRINT (p r 75 � <br />CI7V OF <br />eve rett HEATING SYSTEM: Od GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION I 1 COMBINATION I I BUILDING jXMECHANICAL I I PLUMBING I 1 SIGN <br />OWNER MAILA�ORESS CITY ZIP PHONE <br />�iF�.�rr s�eus.w/�y A.,n.! /90/ r�of3�lilti' <br />TENANT M�ILAODRESS CITY ZIP PI10NE <br />MAILADOflESS LITV ZIP PIIONE <br />GENERQCON7R�CTOR MAILAOONESS CITY ZIP PNONE LICENSEI <br />MEGHNIICA�LONTfUGTOH MI11L�O�RE55 GIIY lIP PHONt LIGtN5E1 <br />.�.Tl;/•�/cr.�ACi, /z9s91.✓oopin/��1t PQ, 1�onain�f llr- 49s7s�63 sin,77� <br />PLUMBINGCONTflAGTOfl MAILADDRESS CITV ZIP PIIONE LICENSEI <br />❑ NEW ❑ ADDITION ❑ ALTERATION I 1 REPAIR I�.l DEMOLITION I. I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />LONTACT PEPSON AND PIIONE NO. <br />""""".....�_�......... "�'?!"J� n_� <br />PROPOSEO USE OF BUIl01N� <br />LEQA� DESCHIPTION OF PPOPERTY (SIIOWN BE�OW OR ATTACN FOUfl COMES� <br />LOT BLOGK OF <br />/ZZ3 i`�o�u�Al' <br />PLUMBING <br />NO. TYPE OF flXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />SHOWER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEPS <br />SUB TOTAL <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK REARSETBACN <br />USE <br />SIDE SEiBACN <br />lYPEOFCONTS.�ILOWABIE ttPEOFtON5CAL1UAl atuvu.cY HOorow[IUHGUNrS <br />cnwv <br />SIZE OF BLDG. NO.OF STORIES BASEMENT <br />OCCUPANCY LO�D FIRE SPRNNLEflS REOD NEIGNT LIMITATIDN <br />INTANE BY I PLANS PPPflOVE00Y CITY OF EVEREIT <br />LOCALSALES <br />TAX COOE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINEO THIS <br />APPLICATION AND KNOW THE 5AME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEqM1T DOES NOT PAESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PRQVISIONS UF ANY <br />OTHER STATE OR LOCAL I.AW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTflUCTION. 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 />CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br />SIGNRTUREOFLONIRRCTORORAUTHORIZEOAGENT DATE L--il-9/ <br />X �, r�c ,CG:- �.D/� Fo,�E�i9n/ <br />�PPLIGANTS CITV BUSINESS LICENSE NO. AND BUSINE55 N�ME <br />MECiiANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PUN CHELK NUAIBEfl <br />UUILOING <br />PLt1MBING <br />MECHFNICAL <br />ADDITIONAL PLAN CHECN <br />OTHEfl <br />STATE BUILOING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />$� ��� � <br />RECEIPT NO. <br />FEE <br />_r <br />� <br />i <br />i <br />i <br />-� <br />N <br />