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APPLICATION FOR CONSTRU��TIc�N PERMIT <br /> everett <br /> � n� rtie Evergreen � <br /> GTV OF <br /> �y everett <br /> C H BUILDING DEPARTMENT <br /> �i3� 259-8810 TO BE COMPLETED IN INK-�P�EASE PRINT <br /> y� � ! DEMOLITION ! COMBINATION BUILDING J�IECHANICAL PLUMBING SIGN <br /> K O OWNEfl MAILADOPE55 CRY =iP �I PHONE <br /> � H � ir. . ,, � i��r-. Z�� 3�1 ��I'� i �-il��� �_ I�'. �V�'ii�� ��^ "�� '' 7`77' `�7 `=�� <br /> N H TENANT MAILApORE55 . CITY 2�P PNONE <br /> y ,,.� .�7�1i1P a�, nLa�na_✓ <br /> O� � 4RCHIiEGTORDESIGNER MAILRDDRE55 CITV ZiP PNONE <br /> �� C GENERALCONTPAGTOR MAILA�DRESS CITV 21P PMONE LICENSE• <br /> �„ n ��� Ilr �1�� ('_„� ���,/��, Ill+ �v� � in � � t���c c.i�.��{( `I�'�DI �5`i- S�IR2 Ui1L_l l=�I<-'• I��L� <br /> � y� MECHANIC/LCONTRRCTOR 'AAILAD�flESS CITY ZIP PHONE UCENSE� - <br /> �� �..� y PLUMBINGCONiPTCTOR IAAII PD�RESS Cltt 21P PHONE IIGENSE t <br /> g�' <br /> H <br /> O C V� CLASSOP WORK <br /> � r '. � NEW I . ADDITION �-LALTERATION � REPAIR DEMOLITION �.-�. WOODSTOVFJFRPL INSERT ! i BUILDING iiELOCAT10N <br /> �.yy TENANTIMPROVEMENTOPINIEPIORq�OMlV� CONTACiPER50NANDPI:ONENO <br /> {�1 <br /> y � y CONTNACiPRICEOF WOfiK: �J� � � <br /> DESCR�OE WORK AND S�URRE FOOTAGE INVOLVED <br /> PHOPOSEOl15EOF0U1L01NG I HEREBY CEFTIFV THAT I HAVE READ AND EXAA9INED THIS <br /> ���_ �) APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> LEGALDESGRIPiIONOFPpOPERTY�SNOWN0El0\VORATTACXFOIIRCOPIE57 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> N'ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ipr otocK oF NC'L THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AP.1 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MA�E AND I COMPLY WiTH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNATIIREOFWNTRACIORORAUiMORiZE�AGENi OAiE <br /> � I � PRDJECTADDPE55 , �t�/� l� 1A I� l�� �C � � il�_�(y I�I�� �7C�(S <br /> �� �'^ � � r qPPLiCRNi5L11VBUSINE55UGEN5EN0AHDBUSMESSNAME <br /> ol �f (If� 1 I\ 1J <br /> 1�I pLUMBING � MECHANICAL <br /> '�' NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. E.A. <br /> '�' LAVATORY(WASH BASIN) UNIT HEAIERS—�.T.U. M _ <br /> ' _ SHOWER CLOTHES DRYERS <br /> KITGNEN SINK 8 DISP VENTILATION FAN <br /> ' DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATER <br /> f_' CLOTHES WASHER JJOOD STOVE ; <br /> URINAL MEIAL PIREPLACE 8 CHIMNEY <br /> ' DRINKING FOUNTAIN FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP <br /> '�' _ BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLE�DERS ExHAUST FAN <br /> e � SINK(SERVICE—BAR.ETC.) _ <br /> � - <br /> �1 — � <br /> �� <br /> . � SUB TOTAL $ SUB TO?AL $ /) ' <br /> PERMIT 5 PERMIT 5 /,�� <br /> TOTAL FEE 5 TOTAL FFE 5 �.-�":' <br /> FPONt SET[fACK REAR SETBACK SIpE SET�ACK PLAN CMEGK NUMBER FEE AECEIPt N0. . <br /> usezor+e LOTAPEF vncnNrsite FEES VALUATION FEE <br /> �', �. VES NO BUILOING <br /> ivPEOfCONSLRLLOWAeIE ivVEO�CONSi.ACtUAI occu�eNCr �.00rrxuuxeurus <br /> cawv pLUM01NG <br /> Si2[OFBI�G. NOAFSTORIES BASEMENT MBCHANICAL ' � � <br /> �. YES �. � NO � <br /> � <br /> OGCIIPANCYL04D FIRESPRNKLERSREO'D NEIGHTLIMIT�TION OTHEF <br /> �-�. YES '. NO STATEBUILDINGSURCHARGE <br /> RI.ASON FOq SPRINKLERS <br /> STATEENERGVSURCHARGE <br /> APPUCATIONRCC.BY PLRNSAPPBOVEOOY CITYOFEVERETT PUBLICWORK$ <br /> LOCALSALES <br /> TAX CODE IS 3105 rorn� •; •� ' <br />