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APPLICATIOI i FOR CONSTRUCT uN PERMIT <br />rne Evrrgreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETFD IN <br />DEMOLITION COMBiNATION BUILDING <br />TEN�tJT <br />ADDNESS <br />GTV 21P <br />CITV ZIP <br />PRINT <br />everett <br />� <br />i . PLUMBING _ SIGN <br />�So� -r��SJ <br />�Q ;ER�LC RRCTOR yµ�,�oq��URAL GAS� INC. GTIx, j p�,(� Z�IP UCENSE� <br />269�6492 — 355.7730 — 742�2944 \�rI L�� V b/�� �� � <br />� MECNANIGLL CONTRAGTOfl M�IL pL`� MCDOUe�II ��T� Z�� PMO E UGENSE � <br />. Wuhin�ton W701 <br />' PLUMBINGCONTR�CTOR M41Lp�DFE55 CITY 21P PMONE UCENSE� <br />CLASS(h WORR � <br />f 1 NEW ��i ADDITION <br />TEN�NTIMPROVEMENTOR <br />CONTRAGT PRILE OF WORI <br />i REPAIR . _' DEMOLITION <br />LEGAI DESGRIPTIONOFPAOPERTY�SNOWNBELOWOPr1TfACHFOURGOPiES� <br />LOT _ BLOCK OF <br />PRQIECT�ODRE55 i1 _ _ <br />URINAL <br />DRINKING F <br />FLOOH DRF <br />BACKFLOW <br />ROOFDRAI <br />SINK �SERV <br />FRONTSETBACR <br />US[ZONE <br />IYPE 0f LON;'t ALLOWABIE <br />SREOFBLIXi. <br />occuanNcvionn <br />REFSON PoR SPRINKlERS <br />RPGLICATION pCG BY <br />OR ITEM <br />WOODSTOVE/FRPL INSERT � '�. BUILDING PELOCATION <br />GONiFCT PERSON RND PHONE NO. <br />I HEREBY CERTIFV THAT 1 HAVE READ AND ExAMINED THIS <br />APPLICATION AND KN� ;! THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVE(iNING TFIIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE Sl'ATE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br />ci�Nq7UR[OFCONTRRCTOROR�UiHORIZEDAGENT DA7E <br />'_`��S�A���-�s-i� <br />RPPUCAHiS CITV pU5ME55lICENSE NO ANO BUSMESS N4ME <br />NC—A/HNDLG UNITS—H P. <br />FORCED AIR SYSTEMS—B.T.U: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DliYERS <br />VENTILATION FAN <br />RANGEHOOD <br />VJATER HEATER <br />WOODSTOVE <br />ME :AL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSEflT <br />HEAT PUMP <br />SUB TOTAL $ <br />PERMIT $ i <br />TOTAL FEE S <br />REARSETP4CK SIOES[TBAf,K PLANCHECKNUMBEIi <br />�j 3i^1 <br />LOTAREA VACANTSITE FEES <br />�'. J YES C i NO BUILDING <br />1Yif U� L�fl$1. A[NRL aCIID�NCY HO Of CN[LLWLONi15 <br />GBOUP <br />PLUMBING <br />NO.OFSTORIES BASEMENT M[CHANICAL <br />I I YES ; �. NO <br />FIRESPRNKLERSREO'D HEIGMTLIMITATION OTH@R <br />[ � VES � NO <br />' STATE BUIL�ING SURCHARGE <br />S7A1E ENERGV SURCHARGE <br />PLhNSAPFROVE09Y CITY OF EVEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAJ( CODE IS 3105 TOTAL <br />TOTALFEE <br />fEE <br />YALUATION <br />$I jJ <br />RECEIPT NO. <br />FEE <br />—�— <br />i <br />1 <br />—r— <br />�r1 _ <br />r, �- � _ <br />