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�� �y �nA� �I1�1 5 <br /> APPLICATION FOR CONSTRUCTIOIv PERMI�' <br /> everett <br /> !he Evergreen � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT i <br /> DEMOLITION ; COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWN MNLADORE55 CITY ZIP PHONE <br /> ���oD� {1o,d�It Ho,�,e� P D Do,r l032 �-Y�v��u�oorl p 9"goyc� S 'lG - 39�9 <br /> iEN�NT MAILr1�DRL55 CITV � 21P PHONE <br /> APCNIiEGTORO[SIGNER MAILAODRE55 Cltt ZIP PHONE . <br /> GENERRLGONiRACTOB MAILR�ORE55 CITV 21P PHONE UCENSE• i <br /> I.Jooc��laVPn Ho�i�ES P � �oX /C3� Lv��., uio� Gdn %'S�JG SY6•s�Jl9 (JoodHN /7%0�' <br /> MECHANICRL GONiRACTOR MFIL AO�RE55 QTY .•P PMONE LICENSE Y <br /> PIUMBINGCONTRAC70R MAILA�ORESS CITV ZiP PMONE LIGENSE� <br /> CUSS OF WORN <br /> X NEW �. � ADDITION � ALTERATION . . REPAIR . DEMOLITION . � WOODSTOVE/FRPL INSERT �. �. BUILDING RELOCATION <br /> 7 EN 1NT IMPftOVEMENT OR IYiER10R REM00[L ONIV LONTFGT PERSON AND PNONE NO. <br /> CONTRFCTPRICEOFWORK: JO/OOC�. C /� � �RC {� E /"� <br /> DESCPIBE�wORKANDSOUAREFOOTAGEINVOIVED <br /> Ue W s i$ o �ryG - 39'!0 <br /> PROPOSEDUSEOiBUII wc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI5 <br /> S � h q�C. FGl lM � �✓ APPLICATION AND KK�W THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGFL DESCRIPTI OP PBOPERTV ISHOWN B OW OR ATTALN!'OUR COPIE51 PROVISIONS OF LAW5 AND ORDINANCES GOVERNING THiS TYPE OF <br /> p r WORK VIILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT�e�_ aiocK oF/�!�-1 C w'OK�I e I"VAc p NOT. THE GRANTING 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 OFi THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOflM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 1827 RCW AND 296200 WAC. <br /> SiGNATUREOFWNiRACiORORAUTMOFIZEDAG[NT OATE ����/Ld <br /> / <br /> PROJEGTADDRESv � ���Cy=�� <br /> � �� � �`� APPUGANTSCITYpU51NESSLICEN5EN0A USMESSNAME <br /> C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 3 WATEF CIOSET(TOILET) !UC—NHNDLG UNITS—H.P. <br /> I BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> 3 LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> .Z SHOWER � � CLOTHES DRYERS <br /> I KITCHEN SINK&DISP � VENTILATION FAN <br /> � DISHWASHER I RANGE HOOD � <br /> LAUNDRY TRAY / W�TER HEATEF <br /> � CLOTHES WASHER --� WOODSTOVE � <br /> UfiINAL � METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ i I <br /> FLOOR DR�IN HEAT PUMP ' <br /> BACKFLOW PREVENTERS � �' GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> " J. � — � <br /> v-.rt.� 1eGn v <br /> i <br /> I <br /> SUBTOTAL S �U ; SUBTOTAL 5 � � Ii <br /> PERMIT 9 PERMIT $ . <br /> TOTAL FEE 5 0 % TOTAL FEE 5 �' "� i <br /> FilONTSETB�LK IiEAR5Ei0ACK� SI�ESETpALK PLANCHECKNUMBER fEE` RECEIPTNO. i <br /> / O � I �l � <br /> usezo LOTAREA 1 vncnru rte FEES VALUATION FEE I <br /> i <br /> ��� �O f YES � NO OUILDING S �f� 7 � � � <br /> iYPEOFCONSi.AIIOWABLE 7YPEOitON51.ALiqAL �cur.y�r ,prnrar.u�.u�.rts / i � <br /> � � cso�n � PLUMBING �yG i� <br /> (/� A/ <br /> 512EOFBLOG. NO.OFSTORIES B/.SEMENT MECHANICAL �.s '� I <br /> / 3 S�9F i J � �. - YES r/f0 <br /> OCCUPANCVLCAD FIFESPRNNlER5RE00 NEIGHTLIMITAYON O1HER <br /> �//�_ i '. VES �O ETATE�UILDINGSURCHnRGE y i,s'� <br /> PEASON FOR SPRMKLER: <br /> STATE�NFRGVSURCHARGE i <br /> APPLICATIONFCC.BY PLANSAPPROVEOBY CITYOFEVE[�ETT PUBLICWORKS �O � <br /> �J'f LOCAL SALES <br /> 7 �' q/�� TAX i3ODE IS 3105 TaTA� �uo <br />