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APPLICATIO.. FOR CONSTRUCTIJN PERMIT <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />I" Evergreen <br />CITY OF <br />everett HEATING SYSTEM: U GAS ❑ ELECTRIC ;d� UVL I <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING <br />' <br />CITY ZIP <br />GINNER MAIL ADDRESS Z52-IQ(�J I <br />vLlN1i/1L AILS Nh `�Ulc1N X� �I/ <br />......r MAIL ADDRESS <br />CITY ZIP PHONE <br />5 [..f� CBY ZIP PHONE <br />AROHITECT OR DESIGNER MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE A <br />CLASS DF WORK <br />NEW AI <br />LOT <br />SIGN <br />ATION F- ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />3 I So CONTACT PERSON AND PHONE NO <br />IRK <br />MARE FOOTAAE INVOLVED / <br />X)FIll �t��inory 70 %crl C <br />DING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />U �u C-1�1 Ft7 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPERTY (SHOWN BELOW OR�)AAI,A FOUR COPIES; WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />BLOCKOF UILAU'I NOT. THE VE <br />AUTHORITY TO ANTING OF A <br />TO VIOLATE OR CANCEL THE PROPERMIT DOES NOT VISIONS OF ASUME TO NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />enPl (CAM 5 CITV BUSMESS IK;ENSE NO ANO BUSINF 55 NAME <br />4? <br />T UIEW I <br />FEE <br />MECHANICAL <br />NO <br />TYPE OF EQUIPMENT <br />PLUMBING <br />FEE <br />NO. <br />TYPEFIXTURE OR ITEM <br />. <br />AIC-A/HNDLG UNITS-H.P. <br />WATER CLOSETET (TOILET) - <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />_ <br />CLOTHES DRYERS <br />SHOWER <br />VENTI'JLTION FAN <br />KITCHEN SINK & DISP <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />�- <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />GAS PIPING <br />— <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL $ <br />S <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETB) <br />Zo <br />20 <br />J <br />USE ZONE <br />LOT AREA <br />VACANT SI' <br />2- <br />v <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OxLp' l <br />OF BLDG <br />BY <br />REGO <br />t10 <br />NO OF OM LAING AIT, <br />APPROVED BY - CITY OF EVERETT <br />qv LOCAL SALES <br />%_x TAX CODE IS 3105 <br />RECEIPT NO <br />VALUATION <br />FEE <br />31 7 L-CHECK <br />MKNUMBEFENUMBERFEE <br />OTHER <br />1 z <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />I <br />