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APPLICATIL 1 FOR CONSTRUC7�N PERMIT <br />Iho Evorgreen everett <br />GTY OF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I i DEMOLITION I I COMBINATION I�BUILDIN(; I I MECHANICAL I:] PLUMBING ❑ SIGN <br />OWNEfl M�IL ApOfiESS CITY ZIP PIIONE <br />� o�B�pt4scw )3oSs MLDo,.•�� tive,ca�t `%SSL o� 2S2 -$'7 9� _ <br />TENRNT MAIL ADDHE55 --i GTY 21P PMONE <br />AflCHITECiORDESIGIlER M.1ILADDRE55 CITY ZIP PMONE '1I ��I�Z1i <br />�uAfl.s—Bouzatrt zolo �5��'S�' ��tie.e.-ef �/�L•3 3�3-GGio <br />FERALCONTRACiOR MRILAODflESS GITY 21P pNONE LIC[NSEI <br />U�cro�c D.ANGe.cv� �A-w.� VicTo►� Aizs CZ. <br />MECIIANIGAL CONiRRGTOR MAII ADDRESS QTY ZIP PIIOflE UGENSE I <br />PluMBINGCONTMCTOfl MAIL�OORE55 <br />QTY ZIP <br />i94Z <br />iA"NEW•V^( I ADDITION 17 ALTERATION I.I REPAIR Cl DEMOLITION I 1 WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br />T[NAN7IMPROVEMGNTOIIINTERIORREMO�ELONLY �P yS� pY1 I LOtlTRCTPERSONFNOPIIONENO. <br />corvrnncrrniceoFwonK: $ j (�� O 4R. /3� <br />DESCRI�[ WOfIR ANO SOIIAflE FOOT�GXINVOLVEC <br />/0 E� S�T• � <br />PP�1'OSED USE OF OUII.DING <br />�y,gGe k <br />LEWLDESC•^/ IPTIONOFPROPEflN�S110WN0ELOV <br />IOT �iC DIOCN OF <br />!� <br />PLUMBING <br />NO. TYPE OF <br />L WATER CLOSET <br />Z BATHTUB <br />2. LAVATORYIWAS <br />KITCHEN S�NK 8 DISP <br />OISHWASHER <br />LAUNDRYTRAY <br />'LOW PREVENTERS <br />DRAINS—RP.INLEADERS <br />i uom sc � �r.K <br />7p <br />��::«< J� - <br />� G� <br />nrt or coxsr ni ioweai e <br />� — l./ <br />SIZ[ OP OLOG <br />U`/ <br />{Z e <br />OLCUP4NLYLOAD <br />/Z <br />R[FSON F00 SPf11NHl EPS <br />�PPI ICA710N ALC 11Y <br />n <br />I f� EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TIiE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTfiER STATE OR LCCAI LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF �ONSTRUCTION. TIiAT 1 AM AUTHORIZED BY THE <br />OWNER OF TFIIS FROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTqACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGN�IUNE OF CONT(iACiOq Ofl AUTMOHIZED AGENI OATE <br />X �4G�+"_i�_l�s:.-..�._—_+--_— %�-lY-�'j�% <br />PVPLIGNI S CII V OI151NESS LIGENSE NO. �ND �USINE55 N�ME <br />�IFf:MSIJI!`!1 <br />N0. TYPE OF EUUIPMENT <br />_` AIC—A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />Z CLOTIIES DRYERS <br />Z VENTILATION FAN <br />� ?j RANGEHOOD <br />9� WATER HEATER <br />_ SUB TOTAL $ � �( ; �— <br />PERMIT $ ---'�— <br />TOTAL FEE $ ' � <br />ncnn s�innr,K sin� semncK <br />'Zo � 5 � <br />IOItRG VACANTSIIE <br />%(�Z.. I I YES I I NO <br />nreorcoNstacmai «c��P��r .aam�xu�xcu�ois <br />STORICS <br />FIRF SPRNHLEIiS RFO'� <br />I_l YES I�NO <br />P�ANSAPP00VEOpY <br />tJ c__c) <br />OASCMENT <br />1 I YES (' <br />IIEIGIIT LIMITATION <br />9 w � <br />CITY OF EVERETT <br />LOCAL SALES <br />TA1( CODE IS 3105 <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />OUIlOING <br />PW61011JG <br />MGCHANICAI. <br />OTH[R ,' C� � / <br />�L <br />STATE B ILDING SUR':Fi1,RGE <br />STATE ENEI�GV SURCHAHGE <br />PU�LIC WORKS <br />TOTAL <br />8 <br />SUB TOTAL <br />ree necemtNo <br />� $ iG `j3 Z (,, <br />FEE <br />