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APPLICAT101.� FOR CONSTRUCTC N PERMIT �VefP�' <br />Ihe Evergreen TO BE COMPLETED IN INK-PLEASE PRINT � <br />CI7V OF <br />everett HEATINGSYSTEM: ❑GAS �ELECTRIC ❑ —� <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOUTION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAILA�DHE55 QTV ZIP Plh]NE <br />c,�A� G�/.�Zy S�is s v��� t�G rl��-r 9�Z o-z. �z��) ,�SZ- /�"Sz <br />TENRNT ' MRILADDRE55 CIiV 21P PMONE <br />ARLNITECT OF DESIGNER MI.IL RD�RESS CITY 21P PHONE <br />GENER�L CONTRACTOR MAII ADDRESS Cltt ZIP �NONE UCENSE e <br />Q �.(/ f% V � . <br />MECHRNICALCONTRnC70R MAtLRODRE55 pTY 2iP PNONE LICENSE� <br />PWMBINGCONTR�CTOR M�ILADDRE55 qiY ZIP PNONE UCENSE• <br />LUSS OF WORN <br />�. NEW I�. ADDITION �� ALTERATION REPAIR . DEMOLITION . WOODSTOVFJFRPL INSERT �. � BUILDING RELOCATION <br />/ CONiALT PERSON ANp PHONE NO <br />� CONTR�CTPRICEOFWORN I� O S� ) �y <br />DBSCRIfl[ WORN ANO SOl1RRE FOOTAGE INVd.VE� <br />/': .i.t /.e;. c r 2 c-- ri4i d/.✓ 6 �il/L [ L . <br />LOT <br />URUING � HEFEBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br />i. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />pF PPOPERiV (SNOWN BELOW OR qTTALH fOURCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />BLOGK ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE Ofi CANCEL THE PROVISIONS OF ANY <br />OiHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHOiiIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B27 RCW AND 2%200 WAC. <br />SIGNATUNEOFWNiRACTORORAUTMOHREDAGENT DATE � "/yI <br />X /.�i / / , , i /lD -- <br />FRQIECT PDOF[SS <br />� <-��? _ S' Y`-'� <br />iINK 8 DISP <br />1ER <br />TRAY <br />WASHER <br />FLOOR DPAIN <br />BACKFLOW Pf <br />ROOF DR�• �S <br />SINK ISkf�VICI <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FNONTSET�AGK RERRSETBAGK <br />USE20NE IOTAREA <br />iYFC Oi CONiS. AIIOWABIE iYPE 0( LONSL. AGNAL <br />SiZEOFBLDG NO.OFSTOHIES <br />OCCIIPANCVIOAD FIRESPRNNlER5RE0D <br />RERSON <br />■� <br />UNIT <br />PLACE 8 <br />INSERT <br />' /`O - �1 <br />N0. RND BUSINESS NRME <br />SIDE SETBACH PLAN CHECK Nl1M8ER FEE <br />VpC�NT SITE FEES <br />BUILDING <br />acuwvcr Moaow�uwcur.�s <br />LB010 pLUMOING <br />BRSEMENT MECHANICAL <br />HEIGNTUMITRTION ADDITIONALPLANCHECK <br />O7HER <br />STATE BUILDING SURGHAFGE <br />CITY OF EVERETT PUOLIC WORKS <br />LOCAL SALES <br />TAX COUEIS 3105 TOTRL <br />M E.A. <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE S <br />RECEIPT NO <br />VALUATION FE�_ <br />�' � � e d <br />�I� <br />3 � � 5� <br />