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APPLiCATI�;�� FOR CONSTRUC1�i�ON PERMIT <br /> 1he Evelg�een f'VE'fB[L <br /> CITV OF r � <br /> everett � � <br /> BUILDING DEPART'MENT <br /> 259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ��DEMOUTION ❑ COMBINATION f I BUILDING CI MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILA�DPE55 q�Y ZIP PHONE <br /> j�AfIL sr��te�t j 3 <br /> AfiGt�ST MA/I,�.+ticH 29�3 �o��•<EF.�'LL�Y'` GYE/'E� 9Rz��� 339 -/ 2 <br /> TEN�NT M41LAUORE55 CI7Y 21P PIIONE <br /> 1�lnvir--� <br /> RRCIUTECTOflDESIGNER MAllA0DRE5S CIiY ZIP PIIONE <br /> �NE <br /> G[NF�P LCONTR�CIOR MI1IL�DORE55 CIIY ZIP PIIONE UCENSE� <br /> ( ,v,��J � <br /> ME�CI�I�NIC�LCONTRr1CTOR MAILPDCflE55 CITY ZIP PHONE �ICENSE� <br /> /(/cT�i� <br /> PLUMBINGCONTRACTOR M4Rn�DRE55 CITV ZIP PHONE LICENSE� <br /> ��,�/G <br /> anss oF wonK <br /> I I NEW I._I A�DITION ❑ ALTEPATION I_1 REPAIR DEMOLITION I-1 WOODSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br /> TENRNT IAIPROVEMENT OR INTERIOR REMODEL ONI.V CONTACT PERSON AND PHONE NO. <br /> CONiR�Ci PRICE OF WOOK: <br /> OESCfiIBE WORK�ND SWARE FOOTAGE INVOLVED <br /> rn POSElSEOFBUIL0ING / /� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �c��L/T/vN SF/� APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGRLDESCRIPTIONOFPROPEIiTY�SHOWNOEIOWOt1ATJ��I/FWPCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTYPEOF <br /> � i+ � ///. � WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OF <br /> iors / f �� a�ucrc i' � ov �:f — ' � NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> `-- AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��-- `- LC��2Q OTHER STATE OR WCAL U1W REGULATING CONSTHUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR RS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNAT EO CIXJTRRC70ROR�UT D�OENT OATE <br /> Z z o �es �/3 0 - 8s=o.� _Wo z <br /> PROJECT A�OIlE55 <br /> A L SI E LI S N .AND BUSINESS NNAE <br /> PLUMBING M HAN AL <br /> N0. TYPE OF FlXTURE OR ITEM FEE N . TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn � C--A/HNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY i <br /> DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAIN.S—RAINLEADERS � EXHAUST FAN , <br /> _ SINK(SEfiVICE—BAR,ETC.) ; � <br /> ' i <br /> i � <br /> i � <br /> i � <br /> � i <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> PERMIT $ -� pERM1T 3 i <br /> TOTALFEE $ ' TOTALFEE S � <br /> Ff10NT5ET0ACK REANSE704CN SIDESE704CN P�ANCNECKNUMBER FEC RECEIPTNO. <br /> US[ZONE LOTAqEA VAC�NTSIIE FEES VALUATION FEE <br /> ❑ YES ❑ NO �— <br /> BUILDING � <br /> IYffOfCON51.ALLOW�BIE 7\PFOfCONSf.�LIUAL acCU�AN[r xOIXNv[WOCUNnS - � <br /> GApIP 1 <br /> PLUMBING � <br /> i <br /> S4E OF BIDG. NO.OF STORIES UASEIAENI MECHANICAL i <br /> I_l YES U NO <br /> � <br /> OCCUPANCVLOAD FIRESPIiNNLERSREOD HEIGIITIIMIIAiION OTHER � <br /> Cl YES f_7 NO STATE OUILDING SURCHARGE � <br /> REASONfORSPflINKLEAS � <br /> STATE ENEFGV SU(1CHAfiGE � <br /> APPI ICnIIONAGC.DY P.ANSRPPqpVEDBV CITY OF EVERETT PUBUC WORNS i <br /> LOCAL SALES ' <br /> TAX COOE IS 3105 TOTAL ; <br />