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APPLlCATILi�I FOR CONSTRUCI �ON PERMIT <br />Ihe Evergreen <br />CIiY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />� � nFneni_ITION I i COMBINATION ' I BUILDING I 1 MECHANICAL LI PLUMBING <br />everett <br />e <br />U SIGN <br />4fiGMIiECTOROESIGNER MUTADORE55 CI1Y ZIP P�����E <br />GfNfMLCOMMCiOR MN..�DOOE55 CIiV ZIP PHONE LICENSE� G`/��Q(.LLT/�rn�-��� <br />��-rl ��L,���.,,Cc�,:;'IT� =r c- ���01-7G�e�''S GJ, /lie�K��{-e � 93�t•�3 3���-�17v5 <br />urcuneicn�conrnncion Mnannon=_ss atv z�r riwr+e LIGENSE� <br />PNMOINGGOHIIIGGIUII M�ILGOUIR.SS � CIIY <br />191UNI I.ICI"NSf � <br />Gtnoa vr n�r.� <br />I I NEW a' ADDITION l 1 ALTEHATION ❑ REPAIR ❑ DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPAOVENENTORINTER:IR�EMOGELd�LY ��)�) CONT�CTPEASONANDPIIONENO. <br />CONTR�CT PRIGE OF WOPK: ��� �—` •-� ��-�• c: ��\ ^rt V� J U n 3.�r� -°1'7 %� <br />PROPOSEO USE OF B111101NQ ' <br />C, cL,.r� o r "r <br />LE(:aL DESCRIPTION OF PNOPERTY 151:OWN BELOW Ofi <br />/� � <br />LOT ,J `Y� TI BLOCK aF _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DR�.INS—FA�NLEADERS <br />SINK (SERVICE—BAR, ETC.)_ <br />SUB TO <br />PERMIT <br />. .. _ .. _ (�� � <br />I15E Z�r � <br />1` <br />1Yf'E Of CON51 ALI OWABLE <br />.�' /./ <br />52E OF BLDG. <br />3 I �f sF <br />OCCUP�NLVLOnD <br />�'/ � <br />R[ASVN fOR SPRINNLERS <br />TPP4C�NpCC �Y <br />i <br />t � <br />RE��SETO��K <br />Z.� <br />LOT AfiEA <br />nrc or coxsc ncruni <br />�' /.� <br />N0. OF STORIES <br />FIRE SPRNNLERS REO'� <br />❑ YES X NO <br />a' J <br />SIDE 5[IO�CN <br />O � dJ �Y�JA _ <br />V�G�NI 511[ <br />❑ YES L�NO <br />aLVrnxf.r unormv[WNGUxrtS <br />B�SEMENt <br />❑ YES � NO <br />NEIGH7 LIMIlAt10N <br />�f� / <br />v�nr+snrrnoveoov I CITY OF EVERE7T <br />��� LOCAL SALES <br />`1 TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXnMINEu inis <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING'iHIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SFECIFIED HEREIN OR <br />NOT. TFIE 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 GONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. Ti1AT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br />APPIICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. Qc� <br />SH'iN�IU�EOFCO.�TP�CTOROBAUi110N12EDAGENT D�iE �Q��a� O / <br />X�� �i,,,�`,�� ae,--% <br />APPLICANTSCItYBUS���E55LIG NSENO.ANOBUSINESSNAME <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS _ <br />VENTILATION fAN <br />METAL FIREPLAGE 8 CHIMNEY <br />H[AT PUMP <br />(iAS PIPING <br />EXHAUST F! <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE <br />_,� ree_,c— 10 <br />. �ti �._�� <br />VALUATION <br />BUILDING <br />PLUMBING <br />MECHANIC�L <br />OTHER <br />StATE BUILDING SUfiCHARGE <br />STATE ENEf7GY SURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />R� Pi N0� <br />�(�._�� <br />b <br />i <br />i <br />. <br />