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APPLICATiI,r�l FOR CONSTRUCI _DI� PERMIT <br />Ihe Evergreen <br />CIiV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING <br />p�+€A � �Mna nooaess �� ^ �cmOl � <br />�—��IC1m ,o.�,-., <br />�_�,�. <br />TE�N^ MRILAD�RE55 pTV <br />DESIGNER 6!11L <br />un <br />21P <br />�ASE PRINT <br />MECHANICAL <br />,� , <br />PNONE <br />❑ PLUMBING <br />everett <br />e <br />❑ SIGN <br />�uuo�rw�nn �� �� <br />❑ NEW C7 ADDITION �TERATION ❑ REPAIR O DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BI.iLDING RELOCATIOr! <br />•���ni�� �mrn�vcM[nl VryIrvIC IV tMUUFLUf <br />�� � <br />CONTR�CT PRICE OF WOPN: 0 � W <br />DESCfl.���D� AGEINV VE[ <br />PPOPZSSEDUS B epING <br />C� <br />IEGAL DESCRIPTION OF PROPERTY �SNOWN OELOI <br />LOT BLOCK OF <br />TYPE OF Fll(TURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEF <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEAC <br />.� L � <br />Y,`. i <br />�f ' FRONTSETBRCK <br />�, '; <br />� <br />' USE ZONE <br />r. . <br />r' I <br />� TYPEOfCONST.RLIOWABtE <br />��; . SRE Of BLDG. <br />occurnNcv�oao <br />REASON FOR SPRINNLERS <br />APPLICATION ACC. OY <br />FEE <br />SUB TOTAL $ � <br />PERMIT $ , <br />TOTAL FEE $ � <br />PEARSETBACK SIDESETBACK <br />LOTAREA VACANTSITE <br />❑ YES ❑ NO <br />7VPEOiCON57.PCNAL OLNPMCY HOOfNV[luNGl <br />CRWF <br />NO.OF STORIES BASEMENT <br />❑ YES ❑ NO <br />FIRE SPRNKLERS REO'D HEIGNT LIMITATION <br />❑ YES ❑ NO <br />PUNSt.PPROVEDBY I CITY OF EVERE7T <br />LOCALSALES <br />TAX CODE IS 3105 <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TI1E WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATllREOFCONTRACTOflOPAli7F{OPIZEDAGENT UATE <br />X �r�. �.�-�� <br />FPPLICANTS CITY BUSINESS LI(S�NSE NO. AND USINESS NAME I <br />MecHaNice� <br />A/(%—A/HNOLG UNITS—H.P. <br />FQRCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLqCE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />M E.A. <br />TOTALFEE <br />CNECKNUMBER FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />ECEIPT NO. <br />a <br />i <br />�� <br />i� <br />