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APPLICATIOld FOR COhiSTRUC'�ION PERMIT <br /> /� /� G/� everett <br /> fhoEvergreen / V F—t• � <br /> CITY OF -- <br /> y r � everett <br /> E�3 t=r y BUILDIN(.; DEPARTMENT 70 BE COMPLETED IN INK—PLEASE PRINT <br /> � � x 259-8810 <br /> y y � DEMOLITION COMBINATION X BUILDING MECHAIVICAL PLUMBING SIGN <br /> t� ONNER CIiV ZIP PHONE <br /> H � � MAILAOORE55 <br /> H H nJt�e�.>s �. � � z. 11'7-<I3Si�5£ �Uercii' 98tiD�} �5�1-L'l �Le <br /> M' y � �NANT � � M�ILADORESS CIiV Z I P PHONE <br /> �iJ H � � � GITV ZIP PMONE <br /> �q {-I AfiCNITEGTOR�E51GNEfl I.INLA�ORE55 <br /> � x � c�'^�'�- — <br /> y � GENERALCONiRACTOP MAILAa0PE5S CITV ZIP PHONE UCENSEM <br /> O H � n r p;�pryE LICENSE N � <br /> Pd � � <br /> h'ECHANICALCONTflPCTOR MAILADOPE55 dTV 21P <br /> 'n� n �uJnC � <br /> H CITV 21P PHONE LICENSE� <br /> '�y' H Ftl'MBRIGCONTRACTOfl MFILAOORE55 <br /> t+ y 0 � � e � <br /> H �-7 anssoFwar+K <br /> d y ;-I NE1'J Y ADDITION � � ALTERATION �. �. REPAIR � -. DEMOLITION �. I WOODSTOVE/FRPL INSERT L! BUILDING RELOCATION <br /> � d �JJ I,,I.L CONTACTPERSONANDPHONENO. <br /> �� � TENANTIMPROVEIdENTORINTEPIpPREMODELONLY Q�e ��C.Y.LN 1 �, n 1 � �,S���r7� L _ <br /> GpNTqAGT PRICE CF YlORK: ��� <br /> 'P.'� 1-3 (A DESCRIOEWORKANDSOWREFOOTpGEINVOLVED � 2G- 3 3� � ` 7(Z M�K ( f!F/�NICN <br /> HOfn 7-!'��yh� - zc a� 2= '�.a5(t�s4r �+ �°tc�.� s�9 - B�SS <br /> PROPpOSEOUSEOFPJILDING \ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> f c� •Na r�� 5��l APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL�ESLRIPTIONd�PROPERtt�SMOWNBELOWOR�TTACNFOURCOPIE51 PFOVISIONSOFLAWSANDORDMANCESGOVERNINGTHISTVPEOF <br /> WORK WILL P.E COMPLETED WITH WHETHER SPECIFIED HEAEIN Orl <br /> �or �.�I�c IY-3�eixH �L.— oF L<. c�� ��u'��.i o.� ��A�� NOT. THE GRANTIMG OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PFOI'ISIONS OF ANY <br /> �rc ec��,ia '�.. �cl ti aS P�n+S OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> /- c c r ' Ta'F'Nw K. PERFORMANCE OF CONSTRUCTIUN.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> q ,.,� � S�„ � A �+�-nk- ��� `� qppLICATION IS MADE AND I COMPIY WITH THE STATE <br /> �t2�—`�"` � CONTRACTORS LAW 1827 RCW AND 296200 WHC. <br /> � � ` �p SIGNATlIiEOFCONTFACTOROB4UTMORIZE�AGENt '1A1E � ��L"� 0 <br /> Ti <br /> ? �L�-1f«.� � �Uri.[ <br /> �1�'1-<1�R� St SE, fo�rc-�+� �J_T� � -�.^�� <br /> , , PROJEGtA0DPE55 AP CANTSCILVGt19NE55liCENSENO.�N��lI5ME5SNAlAE <br /> I���' a (17 ' `� �i rra .S� Pr- <br /> Q PLUMBING MECHANICAL <br /> �+ FEE <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILET) � NG—NHNDLG UNITS—H.P. <br /> BATHTUB J__ FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> 1 '�' UNIT HEATERS—B.T.U. M <br /> I�-' LAVATORY�WASH BASIN) <br /> SHOW ER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILA?ION FAN <br /> ' - DISHNIASHER FANGE HOOD — <br /> � i LAUNORY TRAY WATER HEATFR <br /> a,� WOOD STOVE <br /> CLOTHES WASHER METAL FIREPLACE 8 CHIMNEY <br /> URINAL <br /> D9INKING FOUNTAIN i FIFEPLACE INSERT <br /> ���' FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PHEVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADEflS EXHAUST FAN <br /> SINK(SERVICE—BAfl,ETC.) <br /> _� '_ <br /> i <br /> '�� SUB TOTAL $ PERM TTAL 5 T <br /> �i�� PERMIT 3 <br /> TOTALFEE 5 TOTALFEE S <br /> - � �[CEIPTNO �� <br /> FRONTSETpACK REARSET�ACK SIDESETDAIK PLANCIIEC NUIdBER F[E <br /> �, �,. � � a�s <br /> uSE2oNE/) � �ornaen � vncnnrsrte FEES VALUATION FEE <br /> �`� OOe7 �jQ.(T: . . YES �O 4i4�5U IeU ///rrr <br /> 9UILDING 'k � � � �� � <br /> iVPE0iL0�I5i.AlldW�jBLE iYPEOiLONSi.AC10 f ��ve•:cr naa��nulniauxus - <br /> � a�'�° ' PLUMBING <br /> SIZE OF BLDG^/ NO.OF STOR�ES OASEhI[NT `/ MECHANICAL �_ <br /> �� (���-/, UA2� Z � YES �.7CN0 <br /> OLCl1PANGVLO�P FIRESPRNKLEF-SRIEO'D NEIGHTLIIdIT�ION (� <br /> OTHER <br /> ,_; YES �NO STATE BUILDING SURCHARGE __ 15V <br /> RE�SON FOP SPPINNLERS <br /> S7ATEENERGVSUflCHARGE <br /> ��. a r+snaar.oveoor CITYOFEVERETT �ue!icwoaks L � <br /> �U� �+ �- y�,, LOCAL SRLES — <br /> � Yy�, '/�, �;, TAX CODE IS 3105 TO7AL P� <br /> �` cr�0d��1 is rMn Oa�iJ�o�ixu��l G �luii [luc( PL '� 0.3� (5 <br />; , <br /> . _. r . , <br />