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� � <br />APPLICATION FOR CONSTRUCTI�,N PERMIT eV1��'� <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />f�e Evergreen <br />CI7V CF <br />eve rett �HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />D NG DEPARTMENT <br />BUIL I <br />259-8810 <br />DEMOLITION COMBINATION <br />OWNER h1ARqDDRE55 <br />ARCHITECT OR OESIGNER <br />GENEFALCONTRACTOR <br />MEGHANICAL CONTRACT( <br />N w. S'�c��'.� <br />PLUMBING CONTRACiOR <br />GLASS OF WORK <br />una noor�Ess <br />MAIL i D�RE55 <br />MAII AO�RE55 <br />� <br />MAII ADDRESS <br />I.IAIL <br />BUILDING <br />cm <br />�,.G� , <br />Si,v <br />cm <br />MECHANICAL XPLUMBING SIGN <br />ZIP PNONE <br />r�n,�9,in�I: L,7z-<<i�I1 <br />21P <br />CITV ZIP <br />�V � <br />CIiY 21P �p��12 <br />�o <br />l�n�C' �',�l C�n�l3lup c-S�.k zc � �41(� <br />GRV ZIP <br />�NEW . ADDITION . �. ALTERATION REPAIR <br />/y� Cti <br />LONTqACTPRICEOFWORK I2� Sw• <br />UESGRIBE WORK AH�50114RE FOOTFGE INVOLVED <br />\I�Sra�LQ��mb�r. — flQie�y� 7S2'Z:SF' <br />PROPOSE� USE OF BWI�ING <br />d _ P �s,G <br />LEGAL DESCRIPTION OF PROPEHTY ISMO\VN BEIOW OR ATiALM FOIIR COPIES� <br />IOT BLOCH _ OF <br />PLUMBING <br />0. TYPE OF FIXTURE <br />i WATER CLOSET (TOILET) <br />BATHTUB <br />IZ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN7ERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FFONTSETBACK REARSETBAGN <br />USE 20NE <br />TYPE Of CONiS. ALLOWABLf <br />S�ZE OF BIOG. <br />PEASON FOR SPRINKLEFS <br />INTANE BY <br />ITEM <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />l01 AREA <br />iYPEUFCOGSi.AG1UAl <br />NO.OF STORIES <br />FIRE SPRNNLERS REC <br />PLANSAFPROVEOBY <br />FEE <br />PHONE <br />PNONE LICENSE � [ <br />�,�;wrN��: 5 i �4f <br />PHONE LI{',ENSE� G.z•�.7¢�j <br />`C✓q . <br />742��L�i h,oc,,.Pa,��le�e <br />PMONE LICENSEs <br />DEMOLITION WOODSTOVEIFRPL INSERT ...� BUILDING RELOCATION <br />I CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OADINANCES GOVERNING THIS'VPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOf PRESUME TO GIVE <br />AUTHORITY 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 THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY N/ITFi THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATIIPEOFCONTRACTOROPAUiHORIZEDAGENT DATE <br />X ���,�,�,/��. <br />, <br />pPPLICANi$ CITV BUSMESS LICENSE NO. RND BUSINESS NRME <br />N0. TYPE OF EOUIPMENT <br />- FUC—NHNDLG UNITS—H.P. <br />- FORCED AIR SYSTEMS—B.T.U. M E.A. <br />- UNIT HEATERS—B.T.U. M <br />- CLOTHES DRYERS <br />- VENTILATION FAN <br />- RANGEHOOD <br />WATER HEATEfi <br />- WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />�d U � <br />/O �_ <br />,�sn , - <br />SIOE SETBALK <br />VACANT SITE <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTALFEE 5 <br />CHECNNUMBFR I fEE I RECEIPTNO. <br />..� � �.`)!� <br />BUILDING <br />acur�xa xa o�m+nuxcuxrts <br />,unuv pLUMBING <br />BASEMENi MECHANICAL <br />HEIGHTIIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE 6UILDING SURCHA(iGE <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCAL SALES <br />TAl( CODE IS 3105 TO7RL <br />0 <br />„o <br />MM <br />Oy <br />M <br />� <br />� <br />