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APPLICATII..d FOR GONSTRUCI .ON PERMIT �'Ve�P« <br /> fheEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CI7V OF <br /> everett HEATING SYSTEM: U GAS IJ ELECTRIC IJ _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOUTION I i COMBINATION � BUIIDING �MECHANICAL h PLUMBING i I SIGN <br /> OWNEP AINLA�OOESS cnv zir PIIOIIE <br /> —�J-�+���---��,���� le�an�'� 7h ,c ntd_�o.-1 � � sl,cl, e.�iu,af.�r_ �,�,-�l��.�'.�n��?�,3-79 <br /> TENANI � � Ab\II AUORESb�- "t= —��CII� _'��� LIP �—�- PIION[ -J <br /> S�tl��'� Q��� <br /> �RLHITEGTOP�ESIGNEfI MFILRO�RES$ dfY 21P PIIOIIE . <br /> GENEP�LCON7AACTOR MRII.R�OIlE55 CIIY lll' PIIONf. IICi:N5k1 <br /> G„� s �:•�c�'.:.�.—,8�;33L�67 'nil��_LV.E. � rl;,��u,� `111,Z.Zs • 93,r- y9n�` ; <br /> MEGNANIC�L inncion AIL RbDRESS CIIY 2— 11' v PPONfi IICENSE� <br /> L���`�'� <br /> PLUMBINGCON:FRCTOq hINLA�DRESS CI1V ZIP Vlinryf LICENSEI <br /> CUSS OF WORIc <br /> I I NEW f 1 ADDITION '�LTERATION I � REPAIR I �� DEldOUTION � '�, WOODSTOVE/FRPL INSERT ! i BUILDING RELOC�ATION <br /> CONIAGT PERSOH AND PIIONE i10. <br /> CONiRACT PHIGE OF WORK �� O �3 /� <br /> DESCRIBE WOflNANO5011RRE FnOOIAG[INVOLVCD <br /> C/lun0.f oi�� fc��natC fo iYaru.o.l �sCS <br /> PPOPOSEO�SEOFBUIIDING 1 HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW TI1E SAME TO BE TRUE AND CORRECT.ALL <br /> IEG�LDESCRIPTIONOFPROPEHTY�SHOWNBEL0190f1ATTACI1FO11RCOPILS� PROVISIONSOFLAWSANDORDIN4NCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR � <br /> ior ei.ocK or _____ NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE . <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVIStONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - - — PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNER OF TH�S PROPEFTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAQ . <br /> SIGNAiURE06CON1RACiONORAUT110HIZE0PGENT ORiE <br /> PNQIECTA��RESS � C [>;�1._��C.�i�� /���t1 �t2-t_ ___— __ <br /> � / AI'PI IG4N7S('.HY BII51111155:iCEtlSF NO AND OIISMESS NPM[ <br /> T � <br /> PLUMBING MECHANICAI <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' ` FORCED AIR SYSTEMS—B.T.UJoo�,� E.A. ; <br /> LAVATOFY(WASH BASIN) --�— UNI'f HEATERS—B.LU. M � <br /> --�— — —�— <br /> SH04VER __�_ GLOTHES DRYERS <br /> KITCHEN SINK 8�ISP VENTI:ATION FAN ; � <br /> DISHWASNER --1 RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ' ' <br /> CLOTHES WASHER �— WOOD STOVE � <br /> URINAL ' METAL FIHEPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> — — --'_ <br /> FI.00R DRAIN __ �_ FIEAT PUMP � <br /> --'-------- -- -- � --- ---- <br /> BACKFLOW PREVENTERS I ' GAS PIPING ; <br /> --'— -- ----- ------------- --� -—� - - --- -. _ .. . .--------------- --_--- — <br /> ROOf-DRA�NS—RAINL[ApERS [XHAUST FAN i <br /> .� _. "'_ ""'______ ___ --'—,— <br /> -___— __ .. __... . — . - � <br /> SINK(SERVICE—BAR ETC.) � <br /> � <br /> � _—_ — � <br /> -__t— . .___. <br /> _ __—_____—.--___". _ 1 <br /> T <br /> 1 <br /> �� 1 <br /> - __--_-_ _ -� <br /> I I <br /> Sl1B TOT�L $ SUB TOTAL $ ,S c� 'D p <br /> PERMIT $ � PERMIT S s' � GU <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK NEr1R5El0ACN SIDESE7BACK PIAtldIFCFNUM1lOEfi FEE REC[IPiNO <br /> usezoNE L0IRREA VACA0751iE FEES VALUATION FEE <br /> �UILDING � <br /> iYPfOFGONiSAtIOWABIE 7YPC0lLONSIACfIIAL ttrnw�¢r NoolMnum.uxrtl --- � <br /> caain PLUMDING <br /> — �— <br /> SIZEOFBLDG NOOFSTORIES BASEh1ENT / '3 �D <br /> AIECHANICAL �C' � O <br /> — — <br /> (kCI1PpNCVlO�O FIIIESPONNI[IISII[O� IIH�.IIiII1dITATION <br /> Al1DITIONAI.PI.AN f.IIGCH � <br /> _"__ __'—_.___"_-'__'"___ ____— _ � <br /> i <br /> 011lLli ' <br /> PEASON FOR SPRINKlEPS — —'—T- <br /> ST�TE UUILUING SURCHARGE ; <br /> iNinKe or vi.nr�snrrnoien nv CITY OF EVERETT rupi.ic woiaKs � <br /> LOf.AL SALES <br /> TAX COOE IS 3105 70TAL � � � <br />