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�� � -� � <br />� 1 APPLICATION FOR �COKS7 RUCTerJN PERMIT <br />rhe Evergroen <br />cin oF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ! ] COMBINATION -' BUILDING �GdECHANICAL PLUMBING <br />nwuca . /�. MALLROLAESS . I i] _�. CITY ZIP _ /'� <br />nri � xuri� ►� — <br />MAIL AODRE55 <br />�ESIGNER MAIL�DDPESS <br />l).�i�P_t,t ) <br />CITY 21P <br />CITv 21P <br />LJ � <br />PMCNE <br />VMONC <br />everett <br />e <br />" SIGN <br />PlUM81NGGONTAACTOR MP A CITY IIP PHONE LIfENSEe <br />GI �SS OF WORK <br />,_J NEW ' 1 ADDITION <br />TENRNT IMPROVEMENT OR INTEi <br />CONTRACT PRIGE OF WONN: <br />PROPOSED OSE OF BUIl01NG <br />IEGAL D[SCRIPI r9N OF PFOPE <br />�oT _ o�ocK <br />-� fiEPAIR .�' DEMOLITION ;'�. WOODSTOVFJFRPL INSERT ._i BUILDING RELOCATION <br />� <br />�SNOWN EIELOW OR ATTI.LH FOUR COPIES) <br />oF <br />NO. � TVPE OF FI%T <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY7qAY <br />CLOTHES WASHER <br />URI�lAL <br />DRINKING FC�UNTAIN <br />FLOOfi DRAIN <br />BACKFLOW PREVEN7 <br />ROOF DRAINS—AAIN' <br />SINK (SERVICE—BAR <br />FRONTSEiBACK <br />u5[20NE <br />iY?F Oi MNSi. AILOWABIE <br />SRE OF ULOG. <br />OCCUPANLYLOAD <br />RrpSpN FON SPPINKLERS <br />APPIICATION ACC OV <br />f <br />GONTAGT FERSON AND PMONE 40. <br />I HERE�Y CERTIFY THAT I HAVE READ l�WD EXAMI%vED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE hND COPRECT. ALL <br />PROI'ISIONS OF LAWS AND ORDINANCES GOVERNI4G THIS TYPE OF <br />WORi: WILL BE COMPLETFD WITH WH�?HER SPECIFIED HEREIN OR <br />NOT. TFIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br />OTHER 5T4TE OR LOCAL LAW REGULATING CONSTRUCTION �'R THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZf � BY THE <br />OWN[R OF THIS PROPERN TO PERFORM THE WOn�' !�OR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANO 296200 WAC. <br />SIGNRTUR[OFCONif1ACtOROR t1THORIZEOFGENT DATE <br />X � <br />RPPLiLl.NTS CIiV DUSINESS UCEN`_E NO. RND BUSiNESS NAME <br />MEGMFNICAL <br />NO. TYPE OF EOUIPME <br />A/C-4rHNDLG UNITS—H.P. <br />FOSCC-D AIR SYSTEMS--B.T <br />UM1iT;1EA?ERS—B.T.U. M <br />CL C'lHES DRYERS <br />VE�JTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WGODSTOVE <br />METAL FIREPLACE 8 CHIMNI <br />HEAT PUMP <br />GAS FIPING <br />EXHAUSTFAN <br />SUBTOTAI $ I _j_ <br />PERMIT $ � <br />TOTALFEE $ � <br />� _ _ <br />IiEARSETBACH SIpESETBALK '�ANGNtLKNUTABER <br />LOTFRE� �ACAI:TSITE FEES <br />I i VES ❑ NO pUILOING <br />7YPEOiLON$1ACiUAL o:tuvANtv HJaOwEwNGunnS <br />�a00� PLUM�ING <br />NOAFSTORIES BASEMENT MECHAWI�AL <br />L] YES �� ��. NO <br />FIR[SPPNKLERSpEOD HEIGHTLIMITATION OTHEfl <br />`.-i YES :� NO STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE_ <br />PLRNS RPPROVEO PY CITY OF EVEREI7 PU�LIC WORK$ <br />�� LOCALSALES <br />I TAl( CODE IS 3105 rorn� <br />---�— <br />)TAl $ — <br />f $ — <br />FEE $ — <br />, RECEIPTNO. <br />VALUATION <br />a <br />