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_� <br />��J APPL.lCATION F�R COi�IST6i�1CT10N PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BI�ILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN <br />I J DEMOLITION i I COMBINATION � i BUILDING <br />OYMER MFII D�RESS CITY <br />�-�1.IY�� �'tu�n� ��c � ����tl �/_! 1'�� <br />T �NEy 7� 1. LAO�RESS "—'-"LIIY -- <br />/ 1 A. <br />L_. 1 �.il <br />�RCHITECTOR�ESIGNER MMLAODRE55 CIiY <br />25�9�5492.�—�35-5��7��730 —�y742•2944 <br />RLCONTHAC1D11"'" '""M�I[�O�RESS <br />EverotQ Wefh111�1011 Y�IIUl <br />CONTRACiOR AIAIL RDOReSS <br />CLASS OF WORR <br />l.J NEW IJ A�DITION <br />TENANTIMPROYEMENTOfl <br />CONTRACT PqICE OF WO(il <br />OESCRIBE WORK �N�SOU� <br />OF <br />lEO�L OESCRIPTIOH OF PROPF <br />LOT BLOCN <br />N0. <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />URINAL <br />DRINKING FOl <br />rLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />SINK (SERVICI <br />FpONTSETBRCK <br />115E 20NE <br />7VPE Of CONST ALLdWABLE <br />;eZE OF BL�G. <br />OLCIIPANCY LOAO <br />REASON FOR SPRINNLERS <br />APPLIC�TION ACC. BY <br />iRATION I I REPAIR <br />��� 5_ `), <br />ieo � <br />,.Q_l (�l•1) 1:���1 <br />AW OR ATTACH FOI1R GOPILS� <br />OF <br />CITY <br />arr <br />—PLEASE PRINT <br />i MECHANICAL <br />�(�.1Jt(, Clr�%� <br />ZIP PIIONE <br />-�-21P '�'_'"'-"'_'-'--1'1101lE <br />21P P 1oNE <br />�7� �—� <br />ZIP PHONE <br />i i PLUMBING <br />0 <br />IJCENSE � <br />everett <br />� <br />� I SIGN <br />I DEMOLITION I i WOODSTOVEIFRPL INSERT I I BUILDINC RELOCATION <br />COl1iFGT YEB50N ANU PIIUNE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUI4E TO OIVE <br />AUTHORITY TO VIOLATE Ofi CANCEL THE PROVISIONS OF ANV <br />OTHER ST.4TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 />CONTRACTOHS LAW 19.27 HCW AND 296.'00 WAC. <br />SIGNATUREOFCON7fl�C70RORAUTHORIZEDRGENi D�,7F. <br />X�l� n h ti � L._i . X�i in�Y/ l. ��� <br />FEE � NO. <br />0 <br />ICAM S CI I Y <br />FORCED AIR SYSTEM� <br />UNIT HEATERS—B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />� HEATPUMP <br />; GAS PIPING <br />�— _ T�— ---- <br />d— <br />EXHAUSiF <br />-- ' - -C �C�r'1� <br />. _----'--� I -- ---.. __. <br />—'— — <br />� <br />SUB TOTAL $ � <br />PERMIT $ �— <br />TOTAL FEE $ ' <br />FEARSETBRLK SIDESE7BpCK PLRNCNECKNUA78ER <br />LOTRPEA VALANTSIiE FEES <br />! 1 YES i 1 NO BUILOING <br />irreorcousr.ec7ua� ou��+�x. xoarnrn��ryc��Nns <br />4flq1P PLUMBWG <br />NO.oFSTORif:S oASErnEr+i MECHANICAL <br />I I YES I i NO <br />FIflE SPRNNIFI.' REO'0 IIEIGIIT LIMITATION OTHER <br />I I YES I I NO STATL UUII.DING SUNCI1AfiGE <br />SfATE ENERGY SURCIiPRGE <br />PIANSAPPfl0VE0�Y CITY OF EVERETT PUULIC WORKS <br />LOCALSALES <br />TAX COOEIS 3105 TOTAI <br />& <br />ousiNess <br />TOTAL <br />FEE <br />E.A. <br />$ <br />RECEIPI N0. <br />� <br />i <br />i <br />i <br />�` � <br />