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�-•, <br /> APPLICAT10.1 FOR CONSTRUCT..�N PERMIT evetP1t <br /> �neEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � . <br /> CITV OF <br /> everett �HEATING SVSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTM�NT <br /> 259-8810 <br /> DEMOLITION COMBINATION ,r, BUILDING MECHANICAL PLUMBIN6� SIGN <br /> OWNER r- '�NLPOORE55 GTv ZiP PNON! <br /> .lI}aa c`)lrOv7 ����,,�9�UI��Y /30L, 1l"%,3 � �� 45�'7D _=, 3N . =i.T.� �- <br /> TENRNT MAILADORE55 ITY ZIP PHONE <br /> AqCNIiELiOR�ESiGNER MAllAppfiE55 CITY ZIP PNONE <br /> GEN[RALCONTNPCTOR MAiLqODRESS GITY ZIP PMONE LICENSE� <br /> .��'ltn,-1 C'�„�>� � Ro� -� Ss�i�v✓'c��°�cu,i,� <br /> MELHANICALCONTRACTOR M/ILApDRESS CITY 21P PHONE UCENSE� <br /> PWMOINGCONiRACTOR M�ILppORESS diY ZIP PHONE LIGENSER <br /> CLASS Oi WORK <br /> '7'�NEW , ADDITION ALTERATION . REPAIR DEMOLITION . � WOODSTOVE/FRPL INSERT I.i BUILDING RELOCATION <br /> � / $ CONiPCT PEPSON AND PHONE N0. <br /> CONiRACT PRICE OF WORK l �ti`�---��'" ��l 3'j I <br /> DESGRIBE WOFN RND SOIIRRE FOOiAGG INVOLVED <br /> —7¢-¢-`.' Sf ae — - <br /> PROPOSEDUSEOFBUIL[1ING I HEREBY CER'i�IFY THAT I HAVE ��cAD AND EXAMINED THIS <br /> �(``� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L'cGr1LDESCRIPTIONOFPRO�'ERTY�SMUWN�ELO�YOR�iTACHFOURLOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior J��S o�acK ov 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 OR THE <br /> PERFORMANCE OF CUNSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS MADE AND �OIdPLY WITH THE STATE <br /> CONTRACTOR .LAW 1827 RCW PN 2962UO IVAC. <br /> SIGN�TUREOPC�iqAGTORORAUiVO ZE AGENT OAiE <br /> �" . �l-� <br /> X . <br /> , <br /> Naacr.T nooness � ���� � <br /> 6�� 7 Z N�) DZ �E A P��CA�S CIIY BUSMESS LICE 15E NO RND BUS�NESS NAME <br /> PLUMBING MECNANICAL <br /> NO. TYPE nF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSBT(TOILET) AIC—A/HNDLG UNITS--H.P. I <br /> BATHTUB FORCED AIR SYS fEMS—B.T.U. M E.A. <br /> � LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> —� <br /> ( SHOWER CLOTHcS ORYEflS <br /> 1_ KITCHF.N SINK 8 DISP VENT�.ATION FAN ' <br /> T <br /> DISHNASHER RANGE HOOD <br /> iAUNDRYTRAY I WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAI FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOV!PREVENTERS / GAS PIPiNG <br /> RCOF�RAINS—RAWLEADERS EXHAUSTFAN <br /> SINK(SEHVICE—BAR.ETC.) _ �_ <br /> .klr. tn�v. i«rb'—T= <br /> I <br /> T <br /> SUB TOTAL $ ; SUB TOTAL $ 1 <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ ;c.l. TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBA�H REARS[TpRCIy SIOESETBACK f PtANCMEC NUMI3[R F[E RECEIPTNO. <br /> l7 9/ �G 73� 3 `1�.�70 Y 9.fb d <br /> usc zor+e LOT�REA VAGANT Sli[ FEES VALUATION FEE <br /> ' 7i (Q� 5F4 �u u�rt.l T- <br /> BUILDING Q <br /> 1VPE 01 CONiS.ALLOWABIE 11'CE OF LONSi ACiURL OCCu�eNtv rva q onhuNGunnS S'SS— �I— 0� 5 9 3 ;�s <br /> p PLUMBING ' <br /> � � �� i <br /> 512E BL NO.OFSiOR1E5 BASEMENi MECHANICAL <br /> i�s�a�f+ Z o <br /> OCCUPANCV�OAD FlRESPFNNLEASFEO'D NEIGNTLIMITATION ADDITIONALPLANCHECH <br /> _�� ^ID OTH[fl <br /> liEA50N FOF SPRINKLERS ---� <br /> STATE OUILDING SURCHARGE � �SG <br /> iNrnKe t�v P�aNsnPanoveoov CITY OF EVERETT PUouC WoarcS Z ;� <br /> ' /f� LOCAL SALES <br /> `7' S/g TAl(CODE IS 3105 TOTAL 7� � �S <br />