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r <br /> APPLICATIO�FOR CONSTRUCTl�1 PERMIT e�e«tt <br /> fheEvergraen TO BE COMPLETED IN INK—PLLASE PRINT � <br /> cin oF <br /> eve rett HEATING SYSTEA4: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ' DEM TION i i COMBINATION � BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER AIL�DDNESS LITY 21P PHONE <br /> 6� Glcl�l�tJsK/ l�oll ���1�l7 l�,�. �7��fv,u�5l�/� �£so� <br /> TENANT MAILADDRESS CITY IIP PHCNE <br /> ARL4ITEGTO �ESIGNE MAILADDRESS LIT� ZIP PHONE <br /> �C l�ku/�a /�SZ/ t,��vrr9 liiaua�.� 9xv�T 7-Y3/S'3-'S <br /> GENCOALC ACTOR MAILADDRES CITY ZIP� PNONE LILENSE� <br /> �����- � « <, « < < <� rW,�,�q��� <br /> MECHR CAL CONTRACTOP MRIL ADORESS G�1' 21P PXONE LICENSE t <br /> �— <br /> PLUM6ING CONTRACTOR M�II ADDRE55 CITV 21P PHONE � LICENSE t <br /> �- <br /> CU OF WORK <br /> �NEW l �� qDDITION ��._' ALTERATION . �� REPAIR !-' DEMOLITION I�, WOODSTOV6FRPL INSERT � BUILDING RELOCATION <br /> �� �j . ��Q - CO�t)PERSON•RN`D PMONE N !� <br /> CONTP�GTPRICEOFWORK ���Q� �rfr /�'.;J� L/�N�S �G ����IS�SJ' . <br /> DESCRIBE WORK URR[F T�G INVOLVED � <br /> F�'FCT ,� d� G-'� / � � �2( w � q �f <br /> . PROPO��ous oFpyi� rt+ � I HEREBY CERTIFY T AT I HAVE REA AND EXAMINED THIS <br /> y T APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT.ALL <br /> IEG��DES:.RIPTIONOF PFOPERTV�SHOWN DELOW ONATTACH FOURGOPIE51 PROV'SIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> ' WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> ' ioT_ e�ocK oF _ NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> f� �I ✓ � L—K O AUTHORII�Y TO VIOLATE OF CANCEL THE PROVISIONS OG ANY <br /> � �i(/'J�L'( � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUGTI7N OR THE <br /> %� PERFORMANCE OF CONSTRUCTION.THAT i AM AUTHORI'GED BY THE <br /> I✓ �oa�L� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR YJHICH � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> , CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> , SIGNAIDREOFCONTR�CTORORAUTHOR2EDAGENT D�TE <br /> . A � ~� _ �f YI <br /> �:t...iJ�V�M <br /> PRQIECT AOORESS � / � <br /> G /� �V� APPLIGANTS CITV BUSINESS lW�tq6E N0.AND OUSINE55 NAME � <br /> r��'C/ <br /> � PLUMBING MECNANICAL <br /> NO. TYPE OF FIKTURE OR ITEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/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 VENTILATIO�FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TfiAY WATER HEATER <br /> � CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(S[FVICE—BAR,ETC) ; <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK� SIG[SETB/CK PLANCH CNNUMBER FEE � RELEIPTNO. <br /> � � s� z� 3 � <br /> use zor+e �oT naen vncnr�t siTe FEES VALUATION FEE <br /> �_� BUILDIIJG �4 38� �' <br /> iVPCOfCONiS.4LlOWABIE iYPEOiCONS7.AC70AL MN�eN:r x0o��w[wnGUxcS � <br /> �tT "n0°� PLUMBING <br /> y--IJ —�J —� <br /> SIZGOfULW. NO.OFSW91ES BRSEMENT MECHANICAL <br /> 6 SG I�O <br /> OCCUPANCYLORD FIRLSPRNKLEflSREO'D HEIGHTLIMQATION ADDITIONALPLANCHECK � <br /> � � i <br /> I��� OTHER � <br /> FEASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE � ' � <br /> � 1 <br /> �NiaKE Bv PUNS nPa0oVE08r CITY OF EVERETT P�BLIC WORKS ' <br /> J� LOCALSALES ' — <br /> i/t: 'qL TAX CODE IS 3105 'orn� �/���C � <br />