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APPLICATI�,N FOR CONSTRUCI �ON PERMIT <br /> everett <br /> tha Erergreen � <br /> CITv OF <br /> ���, eve rett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> p x 259-8810 <br /> �H�! [�i� DEMOLITION COMBINATION x BUILDING MECHANICAL PLUMBING SIGN <br /> C p�yryEq MAIIAD�RES$ Cltt �iP PHONE <br /> K'� c��i �"'Y�i�e a93/ CveTsyi.,�•c C�*-rZ� 9��� ozsx-299-Z <br /> I-3 CU T�ryqryT � MAILADDRE55 CILV [iP PMONE <br /> �r�-i� �lA p y.�.c .273/ Lv.T`.r ...t �c:� 9P��/ �.5�?-3Y�i <br /> y � AqCHrtEGTO�IGNER MAi�ADD�ESS CITY ZIP PHONE <br /> �i o ��� Fv �an �0 8.s� Ce..iT 9Y.t•6 �?��- 8Y6o <br /> H]d GENERAI CONTRAGTOR MA�I hDDRE55 CITV ZIP PHONE IICENSE� <br /> H�$ �,lK. ��ia�k ��ts- E���.p` 98z�� �� -�'Y�� <br /> MEGNANICALCONTliACTOR M�itA�DRESS CIiY 21P PNONE LICENSE� <br /> H" a N.�• <br /> �y�' PWA181NGCONiRALTOP MAILAO�FESS CITY ZiP PNONE LICENSEY <br /> [' 2 <br /> HH <br /> �(�J CLASSOFWORK <br /> d� . � NEW . � ADDITION AITERATION . . REPAIR . . �EMOLITION I I WOODSTOV6FRPL INSERT (] BUILDING RELOCATION <br /> 5 TENANTIIAFqWEMENiORINTERIORREAIODELONLY CONiACTPERSONANOPNONENO <br /> c=� e, <br /> � CONTRACTPRILEOFWORN: � �G.OAO <br /> yONOESLRiBEWORNAN�50WAEFOOTAG..E{i�NN]I.VED <br /> I• • di <br /> PROPOSEDUSEOFBVIL�iNG I HEREBV CERTIFV THAT I HAVE FiEAD AND ExAMINED THIS <br /> ��,Q APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGALDESCRIPiIONOFPROPERTY�5110WN9ElOWOHRTTPGNFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WOPK WILL OE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �o* BIOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO �IOLATE OR CANCEI THE PROVISIONS OF ANV <br /> OTHER STATE Ofi LOCAL LAW FlEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL TION IS MADE AND I COMPLY WITH THE STATE <br /> CON RA TORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGN TUR OFGONiRACiORORApiNORIZE�AGENi pAiE <br /> X / . <br /> PRQIEGTA�ORE55 Q / // �—� <br /> f1 ��JI G�IT (•�'"� � PUCANTSGIiY ESSIICENSE fDBUSME55NAM[ <br /> PLUMBING MECHANICAL / <br /> 1�' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> f�t WATEii CLOSET(TOILET) Ai�NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> 1�' SHOWER CLOTHESDRYERS <br /> '�' KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASNER RANGE HOOD <br /> 1 ' LAUNDRV TRAY WATER HEATER <br /> � CLOTHES WASHER WOOD STOVE <br /> �' URINAL METAL FIREPLACE 8 CHIMNEY <br /> � DRINKING FOUNTAIN FIREPLACE INSERT <br /> 1 FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING _ <br /> '� ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> 'iSINK(SERVICE—BAR,ETC.) — <br /> � <br /> �' <br /> ' SUBTOTAL $ SUBTOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FPONTSETBAGN AEARSEI➢RCK SI�ESETOAGK PLIAN �ECKN��� FE� ' � � AECE�NO. J� <br /> � C� <br /> US[20NE LUTRPER VACRNTSiTE FEES VALUATION ( FEE <br /> '3 �I YES , NO BUILOING J'/. � � � <br /> rvPEOiCONSCALLOWPBIF iVFEOiLONSt.ACIDAt uccuoAr.v xoaowuuecvv�.ts +u-y <br /> �_ cvoov p�UMBING � <br /> - I u-� L - 1 I u- -B— <br /> 52[OF BLOG .I. ND Oi SiORiES BASEMENT MECHANICAL <br /> (,p �� TI .�YES :.�, NO <br /> OCCUPRNCYLOAO FIR[SPRNNLEPSRE00 HEIGNTI�MITAiIAON OTHER i <br /> � i.l YES �NO /'Y STATE BUILDING SURCHARGE <) ;�)/ / <br /> _—�_p..«_ <br /> REASON FOq SPfiINKLERS <br /> STATE ENERGY SURLHARGE <br /> RPPLIGRTiONRCGBY PlANSAPPROVEDBV CITYOFEVEflETT PUBLICWORK$ <br /> LOCAL SALES <br /> � ��.:L.- TAX CODE IS 3105 10TAL / �'���� <br />