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� � <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> everett <br /> !he Evergreen ��.i l� C � <br /> l � <br /> CITV OF � <br /> everett i� � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i DEMOLITION I I COMBINATION �UILDING XjMECHANICAL j�LUM8ING SIGN <br /> OWN MRILr1D� S GITY 21P PHONE <br /> ij�E-/7EL —C"�� ��f'!�`�f2u�� �7 � ,��iPr,� �� --?�5�'� <br /> TENANT M41L ADORE55 GIiV 21P PHONF <br /> 4RCHITECTORDES'GNER MFILAD�RESS CITY 21P PHONE <br /> GENERALCONigfR JOR MFIL�ODRESS CITV 21P PNONE lICC115E• <br /> �� —L L��7' <br /> NECH IGL CONTRPLTO /IL AD�(iESS D — CI�� � 21P PNJNE LICENSE� <br /> � • ��.�v �D�z�l�. l3�tvJ <br /> PL MBINGC TRACTOR M/IlPO� $S CITV IP PHONE LILENIS�• <br /> z N � - _4L r � — �K'! ; <br /> SS OF WORK \ <br /> � �(JEW L! ADDITION �. '� ALTEq ON � �. REPAIR �. � DEMOLITION . . WOODSTOVEiFRPL INSERT '.� BUILDING RELOCATION <br /> T NANTIMPROVEA1ENiORINTERIOFREMOD[LONLY CO CTP RSON DPNO ENO. <br /> GONTNACT PRIGE OF wORK: <br /> OESCRIBE W��E FOOT E INVOW�JEO� , _ Su _ <br /> �ll%%l(.1/1.KJ � <br /> raorosE usEOF ILOING I HEREBV CERTIFY THAT I HAVE RE.40 AND EXAMIIJED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE A'JD CORRECT.ALL <br /> LEGRLOESCRIPTIONOF PHOPERTV(SHOWIJ'_LOVlOR ATiAGH FOUR WPIES) PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS NPE OF <br /> WORK WILL BE COAIPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior s�ocK oF NOT. THE GRANTING OF P. PERMIT DOES NOT PRESUME TO GIVE <br /> I ���� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMAF:CE OF CONSTRUCTION.THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICA7'ION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ` SIG ATURE�LQAGTO ROiNORIZEDAGENT OAT�/��/U <br /> PROJECTACO—�. � � ✓ _^�[����J('u i i 1 �(������0/�. 1g�9/ <br /> APPLICANT3 CITY BUS�NE55lICENSE NO.ANO�USiNESS NqME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fq(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORGED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTIIATION FAN � <br /> DISHWASHEH �� RANGE HOOD <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAI FIREPLACE 8 CHIMNEY �� �� <br /> DP.INKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � i <br /> _� � <br /> SUB TOTAI $ �'; SUB TOTAL $ <br /> PEFMIT 5 i/ PERMIT $ T <br /> TOTALFEE 5 TOTALfEE $ <br /> FRONT. � FCN R[AREETBACK SIOESEiBACK PLANCN[CKNUM�ER FEE RECEIPTNO. <br /> U' S ' L <br /> usezone iornaen vncnNrsire FEES VALUATION FEE <br /> �z �d'14 T <br /> ves ; No eui�oiNc $ 38 5N.S ';Of) <br /> TYPEOiLON57.ALlOWABLE iYnEOFCONSi.AC1UAl Mtuaeucv xoao�vuuxGm.i*s <br /> �—/� �� PLUMBING - 77 �� <br /> SREOFBL��.Fr }� NO.OFSTORIES OASEMENT MECHANICAL �M <br /> / 6 i_: YES NO ldL <br /> OGCIIPANCYLOAD FlRESPflNNtERSF[OD HEif.HTLI^MITqQTION OTHER <br /> I � YES �NO L O, STAIE�UILDINGSURCHARGE !L;/� <br /> REASON FOR SPRINKLERS }L�L <br /> STATEENERGVSURCHARGE � <br /> APPIICATIONACG�Y PLAN WEDOV CITYOFEVERETT PUBLICWORK$ <br /> LOCAL SALES <br /> TAX CODE IS 3105 TO7AL � I. � <br /> ��,;�,�t�.�.�� 9�g <br />