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���ld �� ,:.;., �;, . <br />� A PLICATIO`i�l FOR CONSTRUCTi��I� PERMIT <br />l <br />Ihe Evergrnen <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—FL ASE PRINT <br />i I DEMOLITION f 1 CC1dBINATION f I BUILDING � MECHANICAL ❑ PLUMBING <br />OWNER I I� n GMAILA 0 ES✓J I 1�OX ���I� �'�.^! , e lf . �`�1 /\/Y/ I� �� <br />everett <br />e <br />❑ SIGN <br />TENANT MAILADDRE55 CITY ZIF PHONE . <br />r <br />AFCHITECTORDESIGNEfl MAILADDRESS GITY Z�P PHONE �. <br />259•5492 — 355•7730 — <br />MECHANICAL <br />CITY ZIP <br />ucer+,e � <br />Everett, Weehington 9820i <br />PIUMBINGCONTRACTOH MAILADOI7355 CITY 21P PHONE LICENSE� <br />CLA55 OF WORK <br />I J NEW ❑ ADDITION <br />TENANT IMPFOVEMENT OR INTEf <br />CONTRACT PflICE OF WORN: <br />PHOPOSED <br />LEGAL DESCRIPTION OF PROPEHN <br />LOT BLOCK _ <br />❑ REPAIR I I DEMOlITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />I "�1c� <br />L <br />!ED ^ _ <br />L�C / <br />i <br />LOW OR ATTPCH FOUR COP�ES� <br />OF <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />LAUNDRYTRAY <br />CLOTHES WASNER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FRONTSETBACK <br />USEZONE <br />IYPE OF CON57. ALLOWAOIE <br />SIZE OF OLOG. <br />OCCUPANCYLOAD <br />REASON FOR SPRINKLERS <br />�PPLICATION ACC. DV <br />TOTAI FEE $ � ; <br />REARSETB�CK SI�ESEiB�CK <br />IOTAREA ��CANTSIiE <br />❑ YES I l NO <br />lYPEOFCONSt.AC1UAl aeureuer xomowewxeuxns <br />cnour <br />NO. OF STORIES <br />FIRE SPRNNLERS (iEOD <br />IJ YES LJ NO <br />B�SEIAENi <br />f 1 YES I I NO <br />NEIGHT IIMITA'ION <br />PL�NSAPPROVEDBY CITYOFEVEflETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACT PERSON ANO PHONE NO. <br />I HEREBY CEP.Tii=Y THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION l,ND ;<NOW THe SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS ()F LHWS AND ORDINANCES GOVi:RNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOl'. THE GfiANY1NG GF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL Li�W REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TFIIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 18.27 RCN! AND 296200 WAC. <br />SIGNATUREOFCONTP',CTORORAl1THORREDAGENT DATE <br />X �, c.�#C�a� �� <br />� , <br />APPLICANTS CITY BUSINE55 LICENSE NO. AND BUSINESS NAME <br />MECHANICAL <br />TYPE OF <br />UNIT HEATERS—B: <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />PL�NCHECKNOMBER <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEti <br />STATE DUILDING SURCHAf1GE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />E.A. <br />r <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE RECEIPTNO. <br />FEE <br />