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� <br /> APPLICATIO: FOR CONSTRUCT JN PERMIT everett <br /> tne Evorgreen TO 6E COMPLETED IN INK—PLEASE PRINT � <br /> CIN OF <br /> � �j� eve rett �EATING SYST[M: U GAS ❑ELECTRIC ❑_ <br /> m �� , BUILDING DEPARTMENT <br /> Ca H 259-8810 <br /> t" y y�j DEMOLITION COMBINATION BUILDING yNIECHANICAL PLUMBING SIGN <br /> y �' H O1 JER MAIIADDRE55 (� CiiY � ZIP PHONE <br /> K �� `� ,, n � —,.� , ._� �_ -7 �,,z, _._., , <br /> MCy � �- .�� �.� � �' ��,Y� I�.. �_ �i`i � b,,-„�.,���� _ 1�7 !L� �^��S J'f / � � l�:L � i 'r '�,1��� <br /> O� H O� TENRNT MRILAOORESS CITY � 21P PMONE <br /> y y � \ _ - <br /> Zi ARCMRECTOROESIGNER MAILADORE55 GITV 21P PNONE <br /> � � d <br /> �y GENERRLCONTRAGTOR MAILp00RE55 � qCITY 21P p PMONE UCENSE� <br /> ML'�i10 �l'����rnt� 5�%�� 1L'f°� ��- ��J �,_:�e/� �:n�� ,�0.�� ��y�IS�1�� /���-��'��`� ��t��irN(�/' f °.t���i <br /> H�' O M[CHANICr1LCONTPRGTOfl MRILAD�RE55 QTY. / 21P PNONE UCENSE� <br /> ✓ <br /> t" yx <br /> PWMBINGCONTRRGtOR M4ILRDDRE55 CRY ZiP PNONE LILENSE♦ <br /> HH <br /> ti <br /> ��y CL�A/S�OF WOPN <br /> C. �.V NEW i �. ADDITION �. ALTERATION . �iEPAIR . � DEMOLITION . � WOODSTOVE/FRPL INSERT �. � BUILDING RELOCATION <br /> [iJ CONTACT PEPSON AND PHONE N0. <br /> � �<-�,?� <br /> 7.H W GONTRACT PPICE OF WORN <br /> y� � pCSCRIB�\YO�KqND�W�REFOOT\GEINVOLVED — <br /> /t� I! / <br /> � <br /> aRoreseouseqcnw-ort+c I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> �C i ��,Cr� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESGAIPTIONOFPROPERTV�SHOWNBEL0140RATiFCMFOUPCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH N'HETHER SPECIFIED HEREIN OR <br /> �oT o�ocK oF _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I Ah1 AUTHORIZFD BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 296200 AC.-� <br /> SIGNRtUREOFCONiRACTORORAUTMOR2EDRGENT ORTE , <br /> X i ^� �� ��—) C� i,h � � <br /> � ._ l� l/� �� � <br /> � PRQIECTADORE55 - <br /> " ��� -i ��' "l ,'' ._ �l� qPPLICANTSCItVBU5MES5LiCENS[NO.ANDBUSNESSNRME <br /> 1_' PLUMtlING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> f�' WATER CLOSET(TOILET) NC—NHNDL(i UNITS—H.P. <br /> BATHTUB FORCED AIR S�STEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> '��' SHOWER 3 CIOTHES DRVERS <br /> � KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ <br /> ' LAUNDRY TRAY WATER HEATEA <br /> CLOTHES WASHER WOODSTOVE <br /> � URINAL METAL FIREPLACE 8 CHIMNEY <br /> �j DRINKING FOUNTAIN FIREPLACE INSERT <br /> � FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> '� ROOF DRAINS—FAINLEADERS EXHAUST FAN <br /> '-' SINK(SERVICE—BAR,ETC.) <br /> 1' ' � SUB TOTAL $ <br /> �I SUB TOTAI 5 <br /> ' PERMIT 5 PERMIT 5 /S�— <br /> TOTAL FEE 5 TOTAL FEE S n�J' � <br /> FOR OFFICE USE ONLY: <br /> fPONiSETBACN RE�PSET9ACN SIpESETBRCK �LANGNEO"NUMBER FEE REGEIPTNO. <br /> USEZONE LOTPREA VRCANTSITE FEES VALUATION FEE <br /> BUILDING <br /> M'EOFLONiSAIIOWABIE TVPE�iCONSt.AGiOAI oCcunxCr rvo0�untwaauui�5 — <br /> cwouP PLUMBING ' <br /> i <br /> 52EOFBLD(3. NOOFSTORIES BRSEMENT MECHANICAL ' <br /> OCCUPANCVLOPD FIRESPRNNLERSf1E0'0 NEIGHTLiMrtATiON ADDITIONALPLANCHECK <br /> _ ' <br /> OTHER <br /> PEASONIONSPRINKlERS <br /> STATE BUILDING SUfiCHARGE <br /> i <br /> MiAKEBY �LANSAPPpOVEOBY CITYOFEVERETT PUBLICWORK$ <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br />