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4�.-�% <br />APPLICATIL'�J�I FOR CONSTRUCI ��AP� PEFiII�IT <br />evereit <br />tho Evargreen � <br />CITY OF <br />: everett <br />BUILDING DFP4RTiv1ENT <br />259-881C TO 9E COMPLE'I'ED IN INK—PLEASE PRINT <br />CJ DEMOLITION ❑ COMBINATION ! I BUILDING I J MECHANICAL [ 1 PLUMBING ❑ SIGN <br />OWNER �/MAILPDDHESS CITY ZIP SIy��P110NE <br />�yil��la �/r,i ��I°Z S.6—E(37rP/ �`�,N.l a.v�i/ `�tl �i^,� ��r.•,r <br />TENANT `I / MNLA�ORE55 CIiY ZIP � PIIONE <br />�i <br />ARCHITECT OR OESIGNE <br />GlNERALCONTRALTOfl <br />PlUM01N� <br />CUSSOF WORK <br />❑ �1EW ❑ AUDITION <br />TENRNiIMPPOVEMEN�OFINTEI <br />CONTRACT PRICE OF WORK: <br />�OESCRIBE WOiiK nND SOUAflE F <br />� �71i%�-t.r� �� <br />� PROMSEDUSEOFBUILDING <br />LEG, <br />LOT <br />� — <br />MAII AOORESS <br />MAILAD�RE55 <br />MAIL �ODRE55 <br />GIIY CIY <br />CITV ZIP <br />CIIV ZIP <br />I�(l,t•u.rtL �7� <br />arr zir <br />UCENSEt <br />LICENSE � <br />1�f <br />IICENSE • <br />ALTEFATION ❑ REPAIR LI DEMULITION I l WUODSTOVE/FFPL INSERT ❑ BUILQING RELOCATION <br />�OOEL ONLY I CONTACT PEPSON �ND PHONE NO. <br />� �n <br />PROPEfiIY (SHOWN �EL01 <br />BIOCN OF <br />i; <br />PRQIECTADORE55 <br />lYb2 �' - � � <br />� PLUMBING <br />- Np TYPE OF FIXTURE <br />0 <br />WATER CLOSET (TOILET) <br />BATHTU� <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKING FOUNTAIN <br />FLOOR DRAIN <br />9ACKFLOW PREVENTERS <br />AITACH FOUR C07�E5� <br />OR ITEM <br />I HEREBY CERTIFV THAT I HAVE FiEAD AND EXAMINED THIS <br />APPLICATION AND I(NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PHOVISIGNS OF LAWS AND ORDINANCES GOVERNING ?HIS TYPE OF <br />WORK WILL BE COMFLETED WITH WHETHEfl SPECIFIED HER[IN OR <br />NOT. THE uRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O!= AN'f <br />OTHER STATE OR LOCAL LAW flEGULATING CONSTRUC:TION UH THE <br />PE(iFORMANCE OF CONSTRUCTION. THAT I AM AUTHOIiIZED BY THE <br />OWNER OF TF11S PROPERTY TO ('ERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH ThiE STATE <br />CONTRACTORS LAW 1827 flCW AND 296200 WAC. <br />SIGN4TJREOFGONTR�CTOROq�UTHORIZEOAGENT O0.TE <br />X \ � _ � `-1n�1,. ..,. <br />BUSINE55 LICENSE NO. <br />FGRCED AIR SYSTEMS–B.T.U. <br />UNIT HEATERS–B.T.U. M <br />CIOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEF <br />WOOD STOVE <br />METAL FIREPtACE 8 CHIMNEY <br />FIREPLACE INSERT <br />!. ROOF DRAINS–RAINLEADERS --�I— EXHAUST FAN <br />I SINK (SERVICE--BAR, ETC.) i <br />. SUB TOTAL 8 I _ <br />PERMIT $ � <br />� iOTALFEE $ ' <br />FRONT SETORCK REAO SET�ACN SIDE SETBACR PLAN CHECK NUMBER FEE <br />�' USE ZONE LOT AREA �ACANT SITE FEES <br />❑ YES I 1 NO BUIIDING <br />� ' 7VPFOLGONS7.RLLOWABIE lYPEOFCONSLACN�L accUruar xoMow[luxGUxns <br />, cnwP pLUMBING <br />� SIZE OF BIDG. NO.OF SipRIES D�SEMENT MECHANICAL <br />. ❑ YES I_l NO <br />OCCUPANCVLOAD FIHESPRNHLERSREO'D HEIGNTLIMIiATION OTHER <br />� D YES ❑ NO STATE BUILDING SURCH�RGE <br />FlEASON FOR SPRIpNlEflO . <br />� STA7EENERGVSURCHARGE <br />APPlIC4710NACC.BV PLANSAPPROVEDBY g�rYOFEVERETT PUOUCWORKS <br />LOCAL SALES <br />� TAX COOEIS 3105 rora� <br />M E.A. <br />SUBTOTAL $ I� ,$ u <br />PERMIT 8 /r � <br />TOTAL FEE $ �— � <br />RECEIPT NO. <br />VALUATION FEE <br />� <br />i <br />i <br />"_ � _ <br />i <br />-� <br />.�! �- <br />Cs `� <br />