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��^^� F. <br /> ' APPLICATIOIVrFOR CONSTRUCTIt,�I PERMIT <br /> ; <br /> i fhe Evergreen everett ' <br /> ' CINOF � <br /> everett <br /> � BUILDING DEPARTMENT <br /> � 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ; Ll DEMOIITION I I COMBINATION Iy� BUILDING I ! MECHANICAL I I PLUMBING ❑ SIGN ' <br /> .i OWNER MAILAODRE55 QTV 21P PIIONE � <br /> Randy Clark PO Box 708, Mukilteo, WA 98275 348-1320 I <br /> . TENANT MNLADDRE55 CITY ZIP PHONE i <br /> �RCHITECTORDESIGNER MAILADORESS CIiY 7�p PNONE <br /> ,' GENERALCO TRACTO�,`�� MRILAODRESS CI7Y ZIP PHONE LILENSE� <br /> 5� ``�- � �O �rl 708 �uc�(.rr,wlGjt 3y8 r .ta SELCr N 1 ��pk�� <br /> �. MECHRNICALCONTRqCiOfi MqILA00fiE55 CITV ZIP PNONE �,ICENSE� <br /> PWMBINGCONTRRCTOR MFI�ADDRESS CRV ZIP PHONE �ICENSEt � <br /> � CLASSOFWORK '� <br /> � ❑ NEW fj� ADDITION I I ALTERATION I I REPAI I I DEMULITION I I WOOOSTOVE/FRPL INSERT f�] BUILDING RELOCATION � <br /> � <br /> ' TENANT IMPROVEMENT OR INTERIOR REMO L ONLY ' (/YI/ CONiFCT PERSON AhG PHONE NO. � � <br /> � CONTR�CTPRICEOFWORK: � � Rand Clark 348-1320 � <br /> .� UESCRIBE WORN AND SOUARE FOOTAOE INVOLVED ' � �— � <br /> � .-3aaLi l rl .�lut�.alve�.]�C ..y Gi 7�._�e— �. <br /> , PROPOSEDUSEOFBUILOING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> storage APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> .. LEOALDESCFIPTIONOPPROPERiY�SHpWNBELOWORATTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF � <br /> �or $ BLOCK ov Glenhaven Heights WORK WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR � <br /> • NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> . NO. 2 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> . OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE �� <br /> . PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERT'�( TO PERFORM THE WORK FOR WHICH <br /> ', APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. � <br /> SIGN�iUREOFCONiFACTOqORAUTHORIZEDRGENi OATE � <br /> I PPQIECTA ��y�ti(/_� II <br /> ' APPLIC�NTSdTYO�INES UCENSENO.ANUBUSINESSNAME i <br /> i <br /> '� PLUMBING MECFiANICAL . I <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE ' <br /> � WATER CLOSET(TOILET) � A/C--A/HNDLG UNITS—H.P. , I' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. '� <br /> . LAVATORY(WASH BASIN) � UNIT HEATEfiS—B.T.U. M ; � �'�, <br /> ! SHOWER ' CLOTHES DRYERS � i <br /> ' KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> � <br /> � DISHWASHER � RANGE HOOD �' <br /> , LAUNDRYTRAY ; WATER HEATER � � <br /> . CLOTHES WASHER � WOOD STOVE ; �. <br /> ,' URINAL ' METAI FIREPLACE 8 CHIMNEY � �� <br /> DRINKING FOUNTAIt, I FIREPLACE INSERT ; <br /> • FLOOR DRAIN � HEAT PUMP � � <br /> ' BACKFLOW PREVENTERS ' � <br /> � GAS PIPING � i <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � i <br /> , SINK�SERVICE—BAR,ETC.j ; � � <br /> ' i <br /> ' i <br /> ' � <br /> � � <br /> � � <br /> . SUB TOTAL $ ; SUB TOTAI $ � <br /> PERMIT $ � PERMIT $ .' <br /> � TOTAL FEE $ TOTAL FEE $ � <br /> - FRONTSETB�' REARSETB�CI( SIOESETB�CK PLA CHECNNUMBEf1 FEE •, -- RECE�TNO. <br /> .7� � 9� ' 2 ��: <br /> '� usezoe L07AP VACAN7SITE FEES VALUATION FEE <br /> �� 9��� I.I YES ��'�O BUILDING 99�0 9� dv. ��]7S ,��Q '0� <br /> � TYPEOFCONSi.ALIOWFBLE IYPEOFCONSI.AL1Wl octurexCv noOfowEmNGmuiS <br /> 'N cnwr / pLUMBING � <br /> i <br /> �� SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL i <br /> S I I YES �fl NO � <br /> , <br /> OCCUPANCVLOAD FIRESPRNKLERSBEO'D IIEIGHiLIM1T9TION OTHEfi � <br /> ' I.J YES � NO S STATE BUILDING SURCHAliGE i <br /> REASON FOR SPRINKLERS � <br /> STATE ENERGYSURCHARGE ' <br /> � <br /> • APPLICATIONAGC.BV PLANSAPPROVE�BY CITYDFEVERETT PUBLIGWORKS � <br /> � �J� LOCAL SALES ' <br /> 7 io�=. TAX CODE IS 3105 TOTA� �,2 � ,S'S' <br /> , .._,.:,.:...,., . , . .... ..... . . . . .._ ... <br /> ,. <br />