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i <br /> APPLICATIVN FUR CONSTRUCI rON PERMIT <br /> fhe Evergreun everett <br /> GTV OF � <br /> everett <br /> BUILDING DEPARTMFNT <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> I I DEMOLITION I I COMBINATION i I BUILDING I ! MECHANICAL ��PLUMBING I I SIGN <br /> ON?�ER M LADDPE$5 � CI1Y 21P PIIONE <br /> ���f lll�r'i?'l�] ri�'1 ��, O � � l t� � ,� '.-s l/ T i;�'I < f� "I�i7 �i ����i- ��i��_ <br /> TEN�NT� MAILADDRESS CITY 21P pHpNS <br /> APCHITECTORDESIGNER M�ILADURE55 CITV 21P PMONE <br /> GENER�LCONTP�CTOR MRILAOOflE55 CITY IIP PMONE LICENSE� <br /> � � L`�Gf_�/1 L" 1 <br /> MEGH�NICAL CONTflALTOR MRIL ADDflESS CITY ZIP PIIONE LICENSE� <br /> PWMBINGCONTRACTOR AI�ILADDflE55 GITY 21P PMONE LIGENSEI <br /> CLASS Of WOPK — <br /> I 7 NEW I I ADDITION I l ALIERATION I I REPAIR I 1 DEMOLITION I I WOODgTOVEiFRPL INSERT I 1 BUILDING NELOCATION <br /> TEN�NT IMPROVEMENT OR INTERIOH{iEM00EL ONLY <br /> CONIr1C1 PEOSON PND PIIONE NO. <br /> CONTH�CT PRICE OF WOPK: <br /> DESCRIBE WORK AN�SOUARE FOOiAGE INVOI.VBU <br /> r <br /> PROPOSEDUSEOFBl11LDIN� , I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> a ` ,I <br /> � �I f}�'- I('� '{i.t PYI 1 � ` �U_�P� I I 1 I�-' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCHIPIIONOFPROPERTV(SMOWN ELOW OHARAGH FOUR COPI 9� PROVIEIONS OF LAWS AND ORD�NANCES GOVERNING THIS TVPE OF <br /> � � !NOR.✓. WILL BE COMPLETED WITH WIiETHER SPECIFIED HEPEIN OR <br /> io' B�°�" oF — NOT. THE GRAPJTING OF A PERMIT DOES NOT 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 /> OWIJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAI�ION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1A27 RCW AND 296.200 WAC. <br /> SIGNFTUPEOFCONTqACTOPORAUT110R12EDAGFNT DATE <br /> PROJECT�DDRES/S� � I .� ���1..C�P .�C I '�'�' �l�./ 1,� illl� � /� I�'�'�� <br /> '� ��( !,, �( , ('� �� I�� I �J f� p�PLIC�NTS CITV B115MES5 LICQ SE NO AND BI INESS N�ME <br /> I PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ; WATERCLOSET(TOILET) � AiC—A,'HNDLGUNITS—H.P. , <br /> —,_ <br /> i _ BAIiiIUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> _ LAVATORY(WASH BASIN) ---,r— UNIT HEATERS—B.LU. M � <br /> SHOWER ( CLOTHESORYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER �-- RANGE HOOD �— <br /> LAUNDRY TRAV WATER IiEATER � <br /> CLOTHES WASHER —�— \NOOD STOVE ; <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ; <br /> __ FLOOR DRAIN ---�— HEAT PUMP �—r <br /> BACKFLOW PflEVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS —�— EXFiAUST FAN <br /> � <br /> _ SINK(SERVICE—BAR,ETC.) � ��' <br /> i— — ; <br /> - ' � <br /> — i� , <br /> —�— <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERRIIT $ —�—� PERMIT $ �� <br /> TOTAL F[E 5 ' TOTAL FEE $ � <br /> FRON75EiBACN RERRSETBALK SIOESE70ACN PlANG11EGHNUAIBER FEE RECEIPTNO. <br /> USE20NE LOTAqEA VACFNTSITE FEES VALUATION FEE <br /> I I VES I i NO yuILDiNG --r <br /> 7YPEOFCONSTAIIOW�BIL IYPfOfC01157FG1URl ntair�rvtt NoaoN'ulmGOMns — — � <br /> GHpIP 1 <br /> PLUMBING � <br /> � <br /> SIZEOFOLDG NO.OFSTOflIES OASEAIENT MECHANICAL � <br /> i i ves i i No a i ISn <br /> � <br /> OTI{ER ' <br /> OCCUPANCYLOF� FIRESPRNKlEASBEOD HGIGIRLIM17R7101! i <br /> i I YES I I NO STATE BUILDING SURCI1ApGE i <br /> REASON FOR SPPINKIERS � <br /> STATL ENERGY SURClIARGE � <br /> APPLICATIONACC.�V PLANSAPPROVEOOV CITY OF EVERETT PUBLIC WORKS � <br /> LOCALSALES ' <br /> TAX CODE IS 3105 TOTAL 'z1 ;C�j <br />