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� <br />APPLICATION FOR CONSTRUCT�JN! PERMIT <br />the Evergreen � <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—pLEASE PRINT <br />❑ DEMOL'TION ,J COMBINATION ' BUILDIN <br />OR DESIGNER <br />everett <br />� <br />G MECHANICAL I PLUMBING ; SIGN <br />MAIL ADD�%REJS�S /�� L (. q 'j <br />9� /J / �V� ��[�11 C�VI(iGl/D�C��ZIP ( O<�3 PMONE ND ��C(MI.l!✓ <br />MqILADDRESS CITV ZIP PNONE <br />��TM Z�P PMONE <br />� G�f��oQRA�Yi�h �SD/95ss ' citv iP/ �� <br />Z�P PHONE LICENSE • <br />.So > >3 v w�s.�� �if' �£�zo3 3��s-�I <br />MEGHANICALCONTqACTOq MRI�pDDRESS CITY plp PMONE � <br />LICENSE • <br />PLUMBINGCONTPACTOR MAILAODRE55 ��Ty Z�P <br />PHONE LIGENSE I <br />GU55 OF WOPK <br />f 1 NEW C'� ADDITION ,_7 ALTERATION ,. REPAIR bL-DEMOUTION : I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCAT104 <br />TENANT IMPROVEMENT OR INTEFIOR REMODEL ONLV I CONTACT PERSON AND PHONE NO. <br />CONTR�CT PRILE OF WORR: <br />�N. IA. <br />LEGRL UES��ON OF PROPERTY (SHOWN BELOW <br />LOT BIOLK OF <br />LAVATORV (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRY <br />FLOOR <br />TOTAL $ <br />TOTAL FEE S <br />FRONTSETBACK REARSEiBACN I SI�ESETBACK <br />USE20NE I LOTAREq <br />iVPEOfCONSiALIOWABLE I iVPE01CON5i.ACiUAL <br />SIZE OF BLDG. <br />OCGUPANCVLOAD <br />REASON FOR SPNINNlERS <br />APPUCATION ACG BY <br />NOAF STORIES <br />FIRE SPRNKLERS REO'D <br />I.i YES ! ; NO <br />PLANS APPqOVEU QV <br />VACANT SITE <br />� �. YES _ 1 NC <br />occuceva xonrownu�m <br />GHOOV <br />DASEMENT <br />� �. YES : ' NO <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TqUE 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 />AUTHORITY TO VIOLATE OR CANCEL 1'HE PROVISIONS OF qNY <br />OTHEq STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOqMANCE OF CONSTRUCT�ON. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY NITH THE STATE <br />CONTRACTORS LAW 1827 qCW AND 296.200 WAC. <br />SIGNATUREOFCONTRqLTORORAUTMORIZEDAGENT DATE <br />X ��� ��Pir� <br />APPLICANTS CITY BUSME55 UCcNSE N0. AN� BUSMESS Nn1AF <br />FORCED AIR SYSTEMS—B.T,U. M <br />UNIT HEATERS—B,T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />FLAN CHEGK NUMBER <br />BUIIDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FEE PECEIPTNO. <br />FEE <br />a <br />i <br />