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APPLICATI01. FOR CONSTRUCtlkiN �tAW F <br />rett <br />T BE i� <br />the Evergreen O COMPLETED IN INK —PLEASE PRIFil L <br />CIT <br />e OF HEATING SYSTEM: ❑GAS U ELECTRIC <br />nrnlr,r_ Lr 1J11 <br />verett <br />BUILDING DEPARTMENT *- <br />259.0810 U1L41. F I1111f CU;nm r <br />1 DEMOLITION I I COMBINATION BUILDING MECHANICAL ❑ PLUMBING L-I SIGN <br />OWNER MAIL ADDRESS CITY" L 7J' ZiP PHONE <br />84,Ns Co.0 Ra. ofir 3707 t; aK-71G� S**c IVA, 9,,�.y iff-rin <br />TENANT MAIL DRESS CITY ZIP PHONr- <br />tEtDESIGN�R MAILSS <br />CITY ZIP PRONE <br />tMt��sos• ►•a 6T?�ImErLe,«�w.ltlsy _ <br />GENERAL CONTRACTOR MAIL DRE55 ' / CITY ZIT' PHONE LICENSE. <br />_r.,�.-,�.� r (�t: x'e �v 03 776y .Sc S "'/ 7--' - 7: 5 "3 t✓c'iC6 V�i9 co <br />MEGHANI ALCON RACTOR, MAILADDRESS CITY ZIP PHONE LICENSE <br />C(JS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />CLASS OF WORK <br />I I NEW 1=1 ADDITION ALTERATION I I REPAIR I _I DEMOLITION I I WOODSTOVE/FRPL INSERT 1-1 Film nmr. RRI nr.Annu <br />CONTACT PENRiO` D PHONE N <br />LiBACT PRICE OF WORK <br />d1JlW <br />f/•�w�� f`J <br />DESCRIBE WORK AND SQUARE FOOTADE INVOLVED <br />&% <br />rRo_ro`L D�usE DF BuxDINo <br />' <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />�Ibratt 6 `� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF ^RGPLRTY ISHOWN BELOW OR ATIAC14 FOfh COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />Lot BLOCK _ of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />_ <br />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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE O�° CONTRACTOROR AUTHORIZED AGENT DATE <br />PRO,IEC1yA0011E6S <br />• ���' ��. .�.- �� <br />AFKrANTS CITY di S,NE lFlICENSE 10 AND BUS-ESS NAME <br />PLUMING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />CLOSET (TOILET) <br />WATER CLOSET (TOILET( <br />A/C—AMN'DLG UNITS —WATER <br />A/C— UNITS—H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />, <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK 6 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />, <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />J— <br />' <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />T— <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEAOERS <br />, <br />EXHAUST FAN <br />—r-- <br />SINK (SERVICE —BAR, ETC.) <br />, <br />SUB TOTAL E <br />; <br />SUB TOTAL E <br />' <br />PERMIT E <br />, <br />PERMIT E <br />TOTAL FEE S <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />FIIONT SETBACK <br />SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />SIDE SETBACK <br />PLAN�KNNAB II` <br />FEE/_ <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SNE <br />FEE <br />VALUATION <br />FEE <br />BUILDING <br />yJ1 JJJ <br />_ <br />700 , o� <br />TYPE OF CONIS. ALIOWABLF <br />IVPL OF CONSi AC)UAL <br />aWruNr <br />xopwvtulrlc urns <br />PLUMBING <br />SRE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />4109*4k PLAN ('HECK <br />CUPAHCV LOAD , , FINE SPAN LEAS PEG'G HEIGHT LIMITATbN <br />r i <br />REASON FOR SPRINKLERS <br />l L)l <br />OTHER <br />STATE BUILDING SURCHARGE <br />INTAKE OV <br />PLANS PPRDVED BY <br />/Y <br />/ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />, <br />' <br />TOTAL <br />0 7 :; S� <br />I <br />