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APPLICATI�..N FOR COI�STRUC";�:ON PERMIT everett <br /> the Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv oF <br /> everett <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC � <br /> 259-8810 <br /> DEMOLITION -' COMBINATION BUILDING : MECHANICAL �� <br /> �W 1 ry�M�AI DDRESqS� /� (� ���, ZP -�'T�wA181NG . � SIGN <br /> Yl � ��(•� KJZO 1 N\P{qx �'E a V� PHONE p�Q_� <br /> TENAryT MAIL ADDRE55 ���. � J�S—C/CT.�' <br /> Z�P PHONE <br /> ARCHITECT Ofl DESIGNER MAIL AO�RESS <br /> ��rv Z�P PMONE <br /> GENERALCO!lTqpCTOR MAILAODRE55 <br /> CITV 21P PHONE <br /> UCENSE/ <br /> MECHANICAL CONTHACTpR MAIL AODRESS <br /> CITY ZIP PHONE <br /> LICENSE/ <br /> PLVMBINGCO� MAILADDRE55 <br /> CITY ZIP PMONE <br /> UCENSE/ <br /> CUS F WpqK <br /> �� EW _; ADDITION l- ALTERATION ;� REPAIR .-� DEMOUTION . � WOODSTOVE/FRPL INSEflT C BUILDING RELOCATION <br /> CON7ACT PEfiSON AND PMONE NO. <br /> CONTRACT PRICE OF WORK <br /> DESCRIB WORN ANflSCUARE F�T�E INVOIVEp ( W <br /> T�Y-U��J "t"l�� <br /> PRO SED SEOFBUI�DIN �� � <br /> Q I HEREBY CERTIFY THAT I HAVE READ qND EXAMINED THIS <br /> �oTClEs�1P�NOFPROPERTY�BELOWOflATTACHFOURcoai � ^ „ PROVISIONSOF AWSANDORDINANCESGOVERNINGTHSRTYPEOF <br /> �_ BLOCK OF 7 W�O WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF q PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLqTE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LqW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OP CONSTRUCTION.THAT 1 qM AUTHORI2ED BY THE <br /> _ OWNER OF THIS PROPERTY TO PERFORM TY.E WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY W�TH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNATUflEOFCONTRACTppORAUTHORIZEDAGENT DATE <br /> t � �� , <br /> ��/���. X �JuCY" "" i � I <br /> PR0.IECTADDRE55 I�p� ��J� <br /> 1 � � — \I AY yY��^►'f <br /> �' �W{N �� � � APPLICANTSCRVBUSINESSUCENSENO.ANDBUSINESSN�ME <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> FEE NO. TVpE OF EQUIPMENT <br /> WATER CLOSET(TOILET) FEE <br /> BATHTUD � A/�—A/HND�G UNITS--H.P. <br /> � <br /> LAVATORY(WASH BASIN) ' FORCED AIR SYSTEMS—B,T.U. M E.A. � <br /> SHOWER UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER ' VENTIIATION FqN , <br /> � LAUNDRY TFAY � RANGE HOOD � <br /> CLOTHES WASHER ' WATER HEATER <br /> URINAL ' �'✓�D STOVE � <br /> � � <br /> � METAL FIREPLACE 8 CHIMNEY � �— <br /> DRINKING FOUNTAIN � <br /> FLOOR DRAIN ' FIREPLACE INSERT , <br /> DACKFLOW PREVENTERS � HEAT PUMP � <br /> ROOF DRAINS--RAINLEADERS ' GAS PIPING , <br /> SINK(SERVICE—BAR,ETC.) � EXHAUST FAN � <br /> � —�-_ <br /> � <br /> � <br /> i i <br /> i <br /> i <br /> � T <br /> SUB TOTAL $ ' SUB TOTAL $ i <br /> P[RMIT $ , <br /> TOTAL FEE $ PERMIT $ � <br /> � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> fHONTSETBr1CN qEAqSETBACK SIDESETBq�K <br /> PLANCHECNNUMBER FEE RECEIPTNO. <br /> USEIONE LOTAREA VACANTSIiE <br /> FEES VALUATION FEE <br /> 1VPFOfCGN75.AlLOWABLE iVPEOFLONST.ALTUAL BUILDING ; <br /> O[CU�ANCY HO fpMLLiNGOHIi$ <br /> cAWv <br /> PIUMBING � <br /> SIZE OF BLDG. NO.OF STORIES i <br /> BASEMENT <br /> MECHANICAL i <br /> OCCUPANCYLORD FIqESPRNKLEfl5RE0'D NEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> � <br /> i <br /> REASON Fpq SPPINKLERS OTHER i <br /> STATE BUILDING SURCHARGE � <br /> INTRItEOV PLANSAPPROVEDBV � <br /> CITY OF EYERETT pUBLIC WOFKS � — <br /> LOCALSALES ; <br /> TAX CODE IS 3105 TOTAL , <br />