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APPLICATI�N FQI; CONSTRUC7 ON PERMIT <br />the Evergroen <br />CIN OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION COMBINATfON �! BUILDING P.IECHANICAL <br />pWNER MAILADDRESS CITY ZIP�\ P!'ONE <br />MAIL <br />ARCHITECT OR <br />CITY 21P <br />CITV ZIP PHONE <br />everett <br />� <br />PLUMBING � SIGN <br />�� /�h'^`�( L�t� I�nl �571� r�P✓I'i y' G'L. Nl= Gd��n�tTt7.�-� i.>h� i'MI(J :�I�'F�ht�� <br />GENERAL CONTFACTOP lAAll AO�flESS CITV ZIP PMO� IJCENSE a ��r� �. i ��� � <br />n4 N LI�N�'fl�� Tit�v_j,c�L � l� � ��'�i') ������( �Rr•> �>A �a.ilr� D�i•-.,���-5 <br />MECHANICALLONTPFCTOR MAILAOORESS CITY ZIP PNONE LICENSE� <br />f� � � E r�.�4 ��?, �o� �.� r= h�l>n, .�r �� 1— c� �y ��.,� n, � �n �t�•-�� � - ,4��� _ <br />PLUMBINGCONTRRCTOR � �LA�DflESS CITV ZIP PHONE LICENSEM �L��N�Jyii1`k� <br />f?_il-�„�i�P/� P�.�in,RiN�i �•i) �'�o� '�S�I,L�> �,2n-�Tl..a �,� 9�,Ia5 ��.;�-ilNy <br />CLASS OF WORK <br />"� NEW C ADDITION '�. 'i ALTERATION .: RE?AIR '. i DEMOLITION ...' WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION - <br />TENAY.T IMPROVEMENT OR INTERIOR REMO�EL ONLV b as-�cf p(ocK I CONTACT PERSON AND PHONE NO. � <br />.._.. ��. _.� � 1 11c�.t_r_ .,r_�,tl I �_D ��f"]-- i�� L.�) <br />� DESCRIBEWORNANDSOUARE <br />1 <br />i PROPOSEOUSEOFBUILDING <br />� l NO FPM. i.5 <br />• LEGA�DE RIPfIONOFPROPI <br />LOT I � BLOCK <br />"l <br />3 <br />� <br />TvrE oF <br />CLOSET <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />IAUNDRVTRAY <br />CLOTHES WASHER <br />BELOW OR ATTRCM FOIIR COPIES� <br />oF i�I•�T cI- <br />FLOOR DRA�N <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />FRONT SE�TBAG`k � <br />"!N <br />IISE Z� � <br />i <br />iVPE OF LONST PILOWABIE <br />�� o�G� <br />s�N.iT sF : <br />BOv 5f Gn� <br />OCCUPANCVLOAD <br />� <br />REASON FOH SPRINKLERS <br />APPUCATION AGC. DY <br />SUB TOTAL S <br />PERMIT S <br />TOTAI FEE 3 <br />_ '� I SIOE S�TBACK <br />LOT AI7EA <br />iYPE OF LONSi. ACiIIAL <br />IZ'-til <br />NO.OF STORIES <br />2 <br />FIRE SPRNKLERS REO'D <br />I7 YES �SF10 <br />PIANS r�rnpveo ev <br />T�✓� <br />VALANT SITE <br />�YES ! NO <br />aavasc xoorownuncuxrts <br />aAou�P 1 <br />B�SEMENT <br />,C YES �. '. NO <br />HEIGNT LIMITATION <br />A Q • <br />CITY OF EYERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />I HEREBY CERT�FY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAN/S AND ORDINANCES GOVERNING THIF. 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 />AUTHORITY TO VIOLATE OR CANCEf. THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CO�STRUCTION OR THE <br />PERFOFMANCE OF CONSTRUCTION. 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 />C04TRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNqTUREOFCONTflACTOROflAUTMORREDAGENT DATE <br />X �+-- I`�'nRo� �is N ['s��n7rz<x,n.✓ I�X:. <br />pPPL A TS CITY BUS� ICENSE NO. ANO BJS�NE55 NAME � <br />NC—A1HND�C UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOGD STOVE <br />METAL FIREPLACE 8 <br />F�fiEPLACE INSERT <br />GAS PIPING <br />EXHAUST FA�' <br />BUILDING <br />PLUMBING _ <br />MECHANIC�L <br />OTHER /J'�� C� <br />STA7E BUILDINf, SURC' iARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FEE�L/S' { <br />4C <br />VALUATION <br />�IS� �� <br />RECEI�p{� NO <br />/i� <br />� <br />N <br />