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APPLICATION FOR CONSTRUCT��ON PERMIT <br />i= � � � �� / P � ; � /l/��I.�- <br />!he Evergreen " �- �' � � '�� � � <br />CITV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />' Df�.IOUTION COMBINATION D( BUII_DING MECHANICAL PLUMBING <br />pyyryr MAR RDORESS CITV Z�P PHONE <br />� <br />everett <br />e <br />SIGN <br />TENANI MAILApDRE55 LiTY ZiV PHONE <br />S�IY�b A7 OH%w%�e[ <br />ARGHITEGTQRDESIGNER MAILADDRESS CiTY 21P FMONE <br />SAvK� �,7rl� <br />GENERRICONTR�CTOR MRRRDDRE55 qtt ZiP PHONE IICENSE� <br />c_.. _ C4aaE�scN P o 9�x 8l9 s„ieK..us�,wA 982�0 �zo�.).L�f-y/37 -- <br />MECHFNIC�LCONTFACTOR MAII�DORE55 QTY 21P PH04E IIGENSE• <br />PWMBItJGCONTRACTOR MRILADDRESS GTV ZIP PHONE LILENSE� <br />CUSS OF WOFN� <br />� NEW ADDITION . -. ALTERATION <br />iENANT IMFqOVEMENT OF INTERIOR REIAOOE:ONLY <br />CONTR�CT PRICE OF WORN: <br />�ESCPIBE WORN PND SOUAPE FOOTAGE INVOLVED <br />USE <br />f <br />IEGRL OESGAIPTION OF PROPERIY �SHOWN BELOW OR <br />LCT _ BLOLK OF _ <br />8a z i �'"+ Pr,Lu <br />31NG <br />TVPE OF FIXTURE OR ITEM <br />WATER CLOSET�TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWA-HER <br />LAUNDRYTHAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FRONTSETBACH <br />'lA' <br />USE 7 N` <br />iYPE OF CON51. ALLOWABLE <br />�' � <br />SIZE OF BIOG. <br />� O SF <br />OCCUPANCYlOAD <br />—'—�-l-f'�---- <br />REI SON FOR SPRINNLERS <br />RPPLIChT10N FCC. BY <br />REPAIR DEMOLITION WOODSTOVElFRPL INSEFT � BUILDING REIOCATION <br />y� ILI.K C � C11 I CONTACT PERSON AND PNON[ NO <br />_ " r I .� Jl'l �'1 ii7 <br />I HEREBY CERTIFY TNAT I HAVE iiEAD �ND EXAMINED THIS <br />�,,t, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOIIR LOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERPAI? 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 CONSTRUCTION. THAT I AM AUTHORRED BV 7HE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 �iCW AND 296200 WAC. <br />SIGNATUR[OFCONiFPfTORORAUTNORIZEOAGENT OATE <br />X � (/5/90 <br />i..�r <br />.� �,—_ AFPIICAYTSLITV 1 NESSLICENSF. NDBUSM[SSNAME <br />TYPF <br />;ED AIR SYSTEMS—B, <br />i1EATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATEF HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING _ <br />EXHAUSTFAN <br />5 <br />$ <br />REARSETBACN SI�EStinPbn ' / ����� I <br />]A' S � <br />lOT FRE4 VACANt SITE FEES <br />�/] ��O � � YES N� BUILOING <br />_l_ <br />iVVEO�CONSt.ACtUAL oawexcr n0o•onuoneur��5 <br />��/� 90�%� ' PLUMBING <br />NO.OFSTORIES BASEMENT MECHANICAL <br />_�_ . � YES JC NO <br />FIRESPRKK�ERSREUD HEIGHTLIAIITApTIO�N OTHEF <br />�. � YES OC NO � o, S7ATE BUILDING SURCNARGE <br />STATE ENERG� Sl1RCHARG@ <br />PLANS RPP� EDBY CITY OF EVERETT PUBLIC WORK$ <br />LOCALSALES <br />�In � TAX CODEIS 3105 TOTAL <br />M E.A. <br />SUBTOTAL b <br />?ERMIT 5 <br />TOTAL FEE $ <br />FEE � � C� r�( RE <br />J <br />c� <br />a <br />