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APPLICAT101.� FOR C(DNSTRUCTIvN PERMIT <br />IheEverSreen TO BE COMPLETED IN INK—PLEASE PRINT <br />CITV OF <br />everet� <br />BU�LDING DEPARTMENT <br />259-8810 <br />! DEMOUTION ! COMBINATION <br />OlY4EP . , UAIL AO�RESS <br />TENAM <br />ARCHRECT <br />GLASS OF WGRN <br />. - NEW xA,D�DI�TION� <br />ttb✓. o+`_./�'To` <br />CONTR�CT PRICE OF WOFK <br />DESCRIBE WORK AND SOUARE Fi <br />LEGr1L DESGRIPTION OF PROPERI <br />LOi_i�� BLOCN _ <br />MAIL AODREJS <br />MAIL ADORE55 <br />S� <br />MAIL ADOFESS <br />s� <br />MAIL AD�RE55 <br />M41L A�DRESS <br />HEATING JYSTEM: Q GAS <br />everett <br />� <br />X BUILDING XMECHANICAL �(PLUMBING ! SIGN <br />CI� ZIP PHONE <br />'3� � �r17 9A�o_3 <s'� -�J�3 y.5' <br />CITY ZIP PHOIJE <br />CRV 2iP <br />GTY ZIP <br />CRV ZIP <br />CITV ZIP <br />PM04E LICENSE � <br />PHONE i LICENSEx <br />PHONE UCENSE• <br />ALTERATION '. � REPAIR �_-�. DEMOLITION �._�. WOODSTOVE/FRPL!NSERT �� BUiLDINGRELOCATION <br />�— /5, /e1Q � CONTAC'VERSONANDPMONENO. <br />WATER r,LOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTH[S WASHER <br />URINAL <br />DRINKING FOUIITAIN <br />FLOOR �RAIN <br />�ACKFLOW PR=VEN"�ERS <br />ROOF DRAINS--RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />OF <br />I HEREBY CEFTIFY THAT I HAVE FEAD AND F_XAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AIJD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERWING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. f� y I <br />SIGNATURE OF CONTRACTOP OR AUTH091LED AGENT UATE n I <br />I <br />X �� �`��4� <br />APPIICANTS CITY 8 SINE 5 LICENSE N. AND BUSINE55 NAME <br />FEE NO. TYPE OF EOUIPMENT FEE <br />r � — A/�NHNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� — UNIT HEATERS—B.T.U. M ; <br />� � — CLOTHES DRYERS <br />; VENTILATION FAN ; <br />RANGEHOOD � <br />; WATER H�ATER <br />� WOOD STOVE � <br />METAL FIREPLACE 8 CHIMNEY � <br />FIREPLACE INSEFT ; <br />HEAT PUMP � <br />GAS PIPING ' <br />� EXHAUSTFAN � <br />SUBTOTAL $ /$ ; — <br />PERMIT $ —� <br />TOTALFEF $ i� ; " <br />I'^FI OFFICE UStE ONLY: <br />�RONTSETBFCN REARSETBACK <br />� , 2�� <br />USEZONE LOTAflGA <br />�-� ��� <br />IVGEOFC01l75.ALlOWABIE iYPEOFCONSi.ACiUAL <br />SIZE OF BLDG. NO. OF STORIES <br />lJ O <br />REASON FOR SPRINKLE RS <br />INTAKE BY PLFNS Af �ROV[� BY <br />�f� $/,o <br />SIDE Sf:TOACH PLAN CME H NUM9EH <br />5� 9/ .��s�z <br />VACANT SITE FEES <br />�J BUILDING <br />ocavnvcv xoaroweu�veux�is <br />� °p° � PLUMBING <br />enSEM3 7 MECHANICAL <br />N� — <br />MEIGHTLpIMI�fAT10N ADDITIONALPLAN�HECK <br />2�CJ I OTHER <br />STA7E BUILDING SUFiCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTA� <br />SUB TOTAL $ <br />PERMIT $ <br />FEE RECEIPTNO. <br />/��. i.� ,5'.3/� <br />