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... : .a.__ _ .'. . . .. . . .._..'... . . � .. � .. . �.r._ ..,,_' ':, '_'._.. . .� ': , �_' L.:._ ' :'. '. _. .. ..._.e � ..'[W1ti�]ti':II3'�1 <br /> , � <br /> -1 <br /> APPLICATI�rI FOR CONSTRUCT��DN PERMIT ; <br /> everett <br /> fhe Evergreen � <br /> C17Y OF <br /> everett � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> C7 DEMOLITION I 1 COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING fl SIGN <br /> O \ER MRIL ADORESS^ I 1 CITv 21P PMON � <br /> �I��u �Q�Lm�ss�l)IJWe.I�� CI7V 21P � � J � ���� '. <br /> �1 $ RG�i�1�i e2 Q R. �1i22et�-• W�, 4$�.03 ; <br /> ARCHITECTOPOESIGNER MAllA0DRE55 CITV ZIP PHONE . <br /> Oe5��-�v L-�iNe 5 �:o�o - �5?� S�" EVe2e{�^ c�o�. 9�;�0 3 3 �3— 0 53 I <br /> GENERALCONTHACTOR MAILADDRE55 CITY ZIP PHONE LICENSEY <br /> MECHA� �ACTOfl MpILAD�RESS qTV TIP PHONE LICENSE� �, <br /> S�L� <br /> PLU�NGCOflTR'.CTOR MAILADDRESS CITY ZIP PHONE LICENSE� �� <br /> V ��j <br /> cussoF oRK <br /> ❑ NEW �I ADDITION I.1 ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVFJFRPL INSERT C I BUILDING RELOCATION . <br /> TENANi IMPROVEMENi OR MTEPIOR R�ODEI'/�N�O! GQI�TAGT PEFSUNOND PIIQOP�NO. .��3_ 3aa� � <br /> CONTN�CT PRICE OF dORK: %V T�m lJ�r��x �S w � • <br /> DESCRIBEWORKANDSOWFEFOOT EINV VE� � <br /> 1� GoNSrrc.�� ,q�,�,��'Sa1J Sdd S:F ' <br /> �a(Roroseous OFBl1ILDINO / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> -` � �2. �i R ZA M`� S W g�'- F��M 1 L APPLICATION AND KNOW THE SAME Tp BE TRUE AND COPRECL ALL <br /> LEO�LDESCRIPTIONOFPROPEPTVISMOWtrBELOWORATiACHFOURGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> p WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE�N OR <br /> �or� BLOCK �_ oF !7=Ue.r�Ly�OM2S NOT. THE GRANTING OF A PERM'T DOES NOT PRESUME TO GIVE <br /> , \ �( AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> ��G�S O ��I�S�N ..J- 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 COMPLV WITH THE STATE � <br /> � CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. , <br /> SIGNATUREOFWNTRACiORONRUTNORIIE0r1GENT �ATE . <br /> 7^�} I <br /> _yF0.1ECTA�OflE55 y� �� , n q����^ry7Sf.11yppSll�IES�ENSENOANl�OUSINE55NA� ���/�� � <br /> r� � 1<-Cl�� \G�. A/� , <br /> PWMBING MECHANICAL � <br /> N0. TYPE OF FIl(TURE Ofl ITEM FEE NO. TYPE OF EOUIPMENT FEE � <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. '— � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M _�_ �, <br /> SHOWEF � CLOTHES DRYERS ' _ � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � P <br /> � <br /> DISHWASHER � RANGE HOOD � � <br /> LAUNORY TRAY ; WATER HEATER ' � <br /> CLOTHES WASHER � WOODSTOVE _�_ �� <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ; <br /> ORINKING FOUNTAIN � FIREPLACE INSERT _�_ � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � �� <br /> � POOF DRAINS—RAINLEADERS —�— EXH�UST FAN � � <br /> SINK(SERVICE—BAR,ETC.) � • <br /> _ , <br /> � � <br /> — --� <br /> — i <br /> ; � <br /> � � <br /> --r——— <br /> SUB TOTAL $ SUB TOTAL S ' <br /> PERMIT $ � PERMIT $ � ' <br /> TOTALFEE $ ' TOTALFEE $ ' ' <br /> FRONT.ET��K_� RERBSEf9ACK SIOE�ETBACN P NC11E NIIMp PE L l RE�IPT` <br /> civ� �, s ..,�„N� � �.��1 i ��� �� �c_� �9 <br /> usezor+ LOTAREA VACANTSITE FEES VALUATION FEE ; <br /> �t Q[`A I J YES {�f NO BUILDING (n OfJ . <br /> � <br /> iVPEOFCONSi.�IIOWABLE ttPEOFCONSI.�CiOAL aav�xtt xooloW[uirvGuxnS � �� � i � <br /> - `�-�� 2°3 I PLUMBING _�_ � <br /> SIZEOFBLM+. NO.OFSTORIES DASEMENT � � <br /> MECHANICAL ' <br /> sOo Sf AOp,y��v I I YES �' NO � ' � <br /> OCCUPRNCVLOpD FIPESPRNNIERSREOU HEIGIIiLI�MIQTRTION OThIER � <br /> I_1 YES tG NO Go� STATE BUIL�ING SURCHARGE � '�(j � <br /> RERSON FOR SPRINHLERS i <br /> STATEENERGYSURCH�RGE � h <br /> i <br /> APPIIC�TIONACC.BY PIANSAPPROVE�OY CITYOFEUERETT PUBLICWORKS � <br /> i <br /> �.� LOCAL SALES � I <br /> TAX CODE IS 3105 rorn� �Q f. <br /> � <br />