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APPLICATIOrI FOR CONSTRUCT.�N PERMIT <br /> �he Evergreen everett <br /> CIN OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I 1 DEMOLITION I l COMBINATION ih'�UILDING I I MECHANICAL I I PLUMBING I I SIGN <br /> OWNEN MAILAD�RESS CIiY ZIP PIION[ ���� <br /> ���s� � f..isr� l���z Z/ - i�5>c/��i: ,�lE/1��r_'is��,«F i'S'Iln �� <br /> TENAN�� � �— AIRILAODRE55 CIIY IIP P NE <br /> !VC/v'l—. <br /> ARLHITECT�j1ESIGNER MAILRD�RESS GiY 21P PIIONG <br /> �ESSC� �/i'��.0 <br /> GENEnRALCONTfl�CTOR MAILAD�RE55 CI7Y IIP PIIONE LICENSE� <br /> G'�C�i���lZ. <br /> MEGHRiIG�LCONTRACTOR MRII.RODRE55 GiY 21P PIIONE LICBNS[� <br /> PLUMBING CONTRACTOF MAIL AD�RE55 Cltt IIP PI IONE LICENSE� <br /> GlA55OF WORN <br /> 1 1 NEW I. I ADDITION I�LTERATION I'I REPAIR I I DEMOLITION 1 I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> TENANT IMPqOVEMENT OR INTEPIOP REMOOEL ONLY CONTACT PERSON AND V110NE NO. <br /> � / <br /> CONTR�CTPRILEOFWORK: �'� �CJS'�s l/fFN� G+�i��E��E• <br /> DjE/�C RRE WORk�NO SOUJRRE FOOT�GE INVOLVED <br /> /W/l- � / �. '._ .j , <br /> PROPOSEDIISEOFBUILDING 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> /� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEQALUESCRIP NOF PROPERTY�SHOWN LOW OR FTTACH FOUN COPIES) PROVISIONS OF LAWS AND ORDiNANCES GOVERNING THIS TYPE 0F <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or a�ocK oF NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PqOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE � <br /> OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNAIUREOFWMTflACiOqON�UTMOHIZED�GENT �RE <br /> PROJECTAUDRESS � A// /� � � �j//r . � � <br /> _ J�:�s� � �j� �� APP,� ANTuCITVBIISRIESSIICENSENO �N�BUSINESSNAME ' <br /> � <br /> PLUMBIN6 MECHANICAI ! <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE � <br /> i <br /> WATER CLOSET(TOILET) � A�C—AMNDLG UNITS—H.P. i ' <br /> '— _-- <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. �— i <br /> UVATORY(WASH BASIN) —�— UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS —r— <br /> KITCHEN SINK B DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY ; WATEFi HEATER <br /> CLOTHES WASHER — —i— WOOD STOVE ; <br /> — �_ <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR ORAIN —~— HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING <br /> FlOOF DRAINS—RAINLEADERS � EXHAUST FAN �— <br /> SINK(SERVICE—BAR,ETC.) ; ; <br /> � <br /> � <br /> ---- ----------------- -- -- - � <br /> _ ' '. — ----'--_ . _._ .�_---- �-- -------- <br /> T <br /> 1 1 <br /> . ._ __. ..__.._... . ..... . . .... . _.._._ _I . . . __ . . ._ . _....__ __. . 1 <br /> 1 <br /> I <br /> �� � �� <br /> SUB T07AL $ ; SUB TOTAL $ � <br /> PERMIT $ --�— PERMIT $ � <br /> � —•-- <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FRONTSETB�CK REARSET�ACK SIDESGTBACH PLRtlCIIECHNURIOER FEE RECEIPTNO. <br /> USEZONE LOTAREA VACANTSRE FEES VALUATION FEE <br /> 1 1 VES �No euaowc � __L �(`�^� <br /> 7VPEOFW SIAII WABIE iYPEOFCON5I.ACNAL occuasHtr NOIXMtt1lniGmntS – <br /> �-� ,�' ,.i FY'=°g / , <br /> PLUMBING ' <br /> SIZEOFBLOG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> / I �� � � 1 1 YES �NO , <br /> OGCUPANCYLORO FIRESPRNNLEFSflEO'D HEIGHTLIMITATION OTNER � <br /> N I 1 YES �l NC ����� STATE BUILDWG SURGHARGE L i' <br /> RE�SON FOR SPRMKlEOS — <br /> STATEEN[RGYSUHCHANGE i <br /> APPLICAlIONACGBY PIANSAPP00EDUY CITYOFEVERETT PIIBIICWOflKS � . <br /> 'j� _ LDCAL SALES <br /> �i�� TAX CODE IS 3105 TOTAL '�� � <br /> �., <br />