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APPLICATIO�FOR CONSTRUCTI� PEFIMIT <br />the Evergreen TO BE COMPLETED IN INK—PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />HE�TING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />everett <br />e <br />❑ DEMOLITION C] COMBINATION i_! BUILDING ; MECHANICAL G PLUMBING :_l SIGN <br />OWN MAILAODRESS r,�Ty ZIP PHONE <br />(����i / n 1 n <br />l,t�vLG.Li�t�9-c 'f��/ �^'�`�e )rC�'�/�/Gis-, 77�= �Gt �%6/OS .5'`�%'/��?r2 <br />TENANT Mr11L ADDPESS � CITV ZIP PHOhE <br />ARCNI7ECTORDESIGNER MAILADDRE55 CITV 21P PHONE <br />�_Q�- 095�� 1�5`i �S��e�/i�b� <br />r.crua<�r.nNWRCTOR �. 61AILADDRESS �ITY ZIP PHONE LICENSEM <br />MECHANICALGONTRAGIUn <br />PLUMBING CO`ITRACTOR <br />CUSS OF WOHK <br />❑ NEW ❑ ADDITIO <br />� <br />CONiRACT PRICE OF WOPK <br />� OESCRIBEWOP ANDSWRRE <br />� <br />PROPOSE US�BISILDING <br />� <br />LEGALD Sf.RIPTIONOFPROW <br />LOT B�OGK <br />MML AD�flE55 <br />I� ALTERATION <br />PRQIECT A��FE55 <br />�.'�/(3/ L�/.v� s�ee i. <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (N'ASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKING FOUNTAIN <br />FLOOR DRAIM <br />BACKFLOW PREVEIJTC-RS <br />ROOF DRAINS—RAINLEA[ <br />OF <br />FOR OFFICE USE ONLY: <br />FRONT SET�ACN REAR SETBACK <br />USE ZONC <br />iYPE OF WN75. <br />I'1TAKE BY <br />�� SE 1y sc,� rs r� �'/ <br />CITY ZIP PNOPIE <br />GITY LIP <br />��.�C 5 c - <br />" aos N�9 <br />i_] REP.41R '�-i DEMOlITION L,' WOODSTOVE/FRPL INSERT u BUILDING RELOCf.TION <br />I CONTPCT PERSON i.NO PHONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEJ HEREIN OR <br />NOT. THE GRAN'fiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STASE OR LOCAL LAW REGULA'fING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORILED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC RS LALW iB27�OtY AND 296200 WAC. <br />SIGNATUPE�ONTRAyTORO UTHORREDAGENT DATE j//O/„� <br />X / <br />I , <br />N0. <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />LOT AREA <br />TY7E OF CONST. ACTIIAL <br />NO.OF <br />PLANS APPfiOVEU BV <br />i <br />`�)�� � -- o <br />SETBACN <br />VACANT SITE <br />LICENSE N0. AND 9USINESS NAME <br />A/�AIHNDLG UNITS—H.P. <br />FCFCED AIR SYSTEMS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMt <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />.35.3/ <br />BUILDINu <br />OGW�4ICY 1!0 OfV.YflUN60'�I15 <br />t ouc pLUMBING <br />BnSErnEN7 MECHANICAL <br />HEIGHTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALFS <br />TAl( COOE IS 3105 rorn� <br />� _ <br />� <br />SUB TOTAL $ ' <br />PERMIT $ � <br />TOTAL FEE S ' <br />FEE RECEIPTNO. <br />V�LUATION F�_ <br />.7� J�') G</' � � OC/ <br />. � <br />i <br />i <br />� <br />i <br />i <br />i <br />� 5'D <br />i <br />i <br />q'� <br />,x /a � C� <br />