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� <br /> APPLICATI�� FOR CONSTRUCT'rt�N PERMIT <br /> everett <br /> fhe Evergreen <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRiNT <br /> ❑ DEMOLITION I i COMBINATION I I BUILDING X MECHANICAL I I pLUMBING LI SIGN <br /> OWNER MAILADDRE55 CITY ZIP f�HONE <br /> �.�r� �u�s�isir� �ia /l�-z--T��z Ay� S>. S-`nrr�t a✓ns.✓ >��s-y� . 3r�- r3 s3. <br /> TENANT MNLAOORE55 CITY ZIP PHONE . <br /> ARCHITECTOROESIGNER MAILADOHE55 CITY 2�P PHONE <br /> �il/�2r..c} /'.7..tl.�✓ 3 ntto�. ).5�1 (�e..:¢�7 (,�i'+. �-.-t:cr� r.r�il. y�rc.,s � 3s� -zds.� <br /> GENERALCONTflAC70R MAILAOOFESS CITY ZIP PHONE LICENSE/ <br /> �tin'J �v:S1:na..:.rrJ f:J /tt+2..L�.-e_. �?..:. s��. S/.%.arl'c: GAe�� SS��>y' �i71'.vV27SL/ <br /> MECNANICAICONTRnCTOR MnILA0UFE55 µ, CITY ZIP PIIDNE LICENSEf <br /> �i-sfhYY /3yZo -�/c� �v` /Jiu.�.�..r< L�4�/. y�.�T L53-JJ'3� -T�S'-STS�f.2ySN� <br /> PWMBINGCONTRACTOR MAIL�ODRESS CITV ZIP PHONE LICENSEN <br /> CLASS OF WORK <br /> ,�!,NEW I 1 ADDITION I I ALTEFiATION ! I REPAIR I ! DEMOLITION � ! WOODSTOVE/FRPL INSFRT f I BUILDING REIOCATION <br /> T[N�NT IMPROVEMENT OR M�ERIOR REMODEL ONLY COHT�CT P[PSON nND PHONE NO <br /> CONTFACT PRICE OF WORN: Ul'-�`��t�- <br /> OESCRIBE WORKANO SOUARE FOOTAGE INVOLVED <br /> /:7/�:� . i <br /> PROPOSEDUSEOFBUILOING I IIEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS I <br /> APPLICATION�ND KNOW THE SAME TO BE TRUE AND CORRECL ALL I, <br /> LEGRLDESCRIPTIONOFPROPERTV�SHOWNBEIOWORAITACNFOURCOPIES� PAOVISIONSOFL.4WSANDORDINANCESGOVERNINGTHISTYPEOF i <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIii OF j <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT GOES NOT PRESUME TO GIVE 'I <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY I <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> �D �� � � Z y� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> /' v �y CONTRACT RS LAW 1827 RCW AND 296.200 WAC. � <br /> �Q /f� �'(pJ J SIGNA�F�R�OR�Ui1 IZE�AGENT DAiE �—I�—�� I <br /> � I <br /> PROJcCTA0DRE55 I <br /> _ ////. (�/7L" 57., /�-_`�'?, l ,� �/ 1/ APPLIC�NISLITYAUSWESSLICENSENO.ANDBUSINESSNAME <br /> /' � "�* <br /> PLUMBING MECHANIGAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATFR CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. �_ I <br /> BATHTUB ; FORCED AIH SYSTEMS—B.T.U. M E.A. � I <br /> LAVATORY(WASH BASIN) UNIT h1EATERS—B.T.U. M � <br /> � T <br /> SHOWER ; CLOTHES DRYERS � i <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER � _ I <br /> CLOTHES WASHER — i WOOD STOVE i I <br /> . URINAL ' METAL FIFEPLACE&CHIMNEY �— <br /> DRINKING FOUNTAIN FIREPLACE INSERT : ! <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> f100F DRAINS—RI�INLEADERS EXHAUST FAN � <br /> � SINK(SERVICE—BAR, ETC.) ; ' <br /> — � � <br /> - �� I <br /> 1 j- <br /> 1 <br /> I I <br /> � �� <br /> I 1 <br /> . SUB TOTAL 5 SUB TOL\L 3 ; ' <br /> . PERMIT 5 � PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FflONTSETBACK REARSETBACK SIDESETBACN PLANCHECKNUId�ER FEE REGEIPiNO. �, <br /> usezoNe LO7PFEA VACANi51TE FEES VALUATION FEE I <br /> � I I YES I I NO pUILUING —�— I <br /> TYPEOFWN57ALLOWABLE TYPEOFCONSI.ACNAI or.tUPAntt xaorpwEwxGUNnS � ' <br /> aimuv <br /> PLUMBING � <br /> SIZEOFBLOG. NO.OFSTORIES BASEMENi MECHANIC�L I � <br /> I 1 YES I I NO — --t � <br /> OCCUPANCVLOR� FIPESPRNNI.EIiSflE00 IIEIGHTL16/1TATION OTHER � <br /> I_I YES I. I NO S-fATE BUILOING SUF7CHARGE ' <br /> ' REASON FOP SPRINKLERS — <br /> . S fAiE ENERGY SURCHARGE i <br /> APPUCATION ACC.BV PLANSAPPPOVEO DY CITY OF EVERETT PIJpLIC WOFiKS � <br /> LOCALSALES � <br /> TAX CODE IS 3105 T��*A� � <br /> t: - :ry . .a.f . . . . <br />