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.:.�` P'__y <br /> APPLICATION FOR �CONSTRUC7 .ON PERMIT <br /> fie Evergreen e�rerett <br /> CITY OF � <br /> ��>� everett <br /> D ;o x BUILDING DE�ARTMENT <br /> y y y 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> �� DEMOLITION COMBINATION _� BUILDING !=i MECHANICAL ] PLUMBING - SIGN <br /> y�� OWNER M LADDRE55 n CITY ZIP PHONE <br /> �H� —��1,� �U�IC��CzS S3�v ��-�"Qi. �,J Y�n�IUI-�tz� l,-�n °i�z� � Z��7Ne� �18L <br /> TENANT InAILA�DRE55 CITY ZIP PNONE <br /> �� . <br /> yx �y <br /> ARC ECTORLESIGNER MFILA�DFE55 JIiV ZiP PHONE <br /> � ,� ry I VM �X,l,�m ctn�'�. <br /> O H GENFRALCONTRACT R MAILAO�RE55 CiTV 21P PHJNE LICENSEr <br /> ��g ���u� r�u �d�2- �cic.�� �3��4�� <br /> MECHANICALCONTPACTOR M !LAODRE55 CITV ZIP PHONE LICENSE� <br /> �y� No� Pa��� 1�,�hw�, �z.�tH1� �S -Iu��-1 <br /> PIUM GCONTflAGTOR MRILADOFESS C17V ZIP PHONE �ICENSE� <br /> g�y �'fcvv�v��� '�t utnnb i n�j �VErf'Ct— 3u"1 -I B�FU� <br /> A _� y CLASSC�WOflK _ <br /> Cd X.' NEW ❑ ADDITION ❑ ALTERATION .__: REPAIR �; DEMOLITION i_: WOODSTOVE/FRPL INS�FT '_.� BUILDING RELOCATION <br /> � TENANT IMPROVEMENTOF IN7Efl10R REMO�EL O�NL�Yp� O� CONTAGT PERSON q�N�D\PM,�ONE NO. Z ,I�;1 <br /> HO�A �CONTRAGTPflICEOFWORK: 1��.�)(�J . wC�I � � J���Y�/ <br /> – � -- UESCRIBE WOFK AN"SOUr1RE FOOTAGE INV LVE� <br /> 3 t>zv � 3y��az <br /> PPOPOSEOUSEOFBULDING � �.,���p� I HEREBY CERTIFY THAT I HP,VE READ ANG EXAMINED THIS <br /> � lJt -t��,�– A('PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL]ESCFIPTIO� i01V�5HpWN8'IOWORATTACHFOURCOPIES) PflOVISIONS 0F LAWS PND ORDIlJANCES GOVEFiNING THIS NPE OF <br /> -lk WORK WILL BE COMPLETE�WIiH WHETHER SPECIFIED HEREIN OR <br /> . ior_ � BLOCK __ CF �'�N�luX� �� NOT. THE GRANTING OF A PEIaM1T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEI THE PRJVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOPIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 fiCW AND 296.200 WAC. <br /> SIGt:ATUREOFCONiRACTORORPUSHORREDAGENT �FTE � <br /> � (\�y,� <br /> '�' PPQIJ IDL)5� �I � / lY� � � ��1���/�/�✓ / Ivlf�/V / _ . <br /> RPPL RSCItt BUS�NE55�ICENSE NO. D BUSME55 N�id�T—� <br /> '�' PLUMBING MECHANICAL <br /> N TYPE OF FIY.TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> '�� WATER CLOSET(TCILET) �' A/C-NHNDLG UNITS-H,P. <br /> ' ' dATHTUB — FOFCED AIR SYSiEMS-B.T.U. M E.A. <br /> � LAVATORV(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER - CLOTHESDRYERS � <br /> ' KITCHEN SINK S DISP _ - VENTILATION FAN <br /> ' DISHWASHER - RANGE HOO� <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> '—' UAINAL _ � i M11E?AL FIREPLACE 8 CHIMNEV � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> 1�' FLOOR DHAIN HEAT PUMP �— <br /> � BACKFLOW PR�VENTERS 6AS PIPING <br /> ' ROOF DRAINS�-RAINLEADERS EXHAUST FAN <br /> 1�' SINK(SE:RVIf:E-BAR,ETC.) <br /> � <br /> �' <br /> �' SUBTOTA� $ SUBTOTAL S <br /> '��""-- PERMIT $ PERMIT $ <br /> TnTAL FEE 5 TOTAL FEE $ -'�-- <br /> FRON'i5`ET8ACK flEARSETBACK SIDESET9ACK � PLAN HECKN,u{M�O/ER FEE 1 Q REL���jjjppp�ir���O <br /> (� , �.5 , Y .t��� ✓✓ /'J �i 117_ � <br /> USE:ONE �ornqea VAGANT FEES VALUATION FEE <br /> R 5 J� �h p �: ves � No euuoiNc �'i?4 ?7 f � ' � <br /> 7YPEJiCON51.AtlON'ABLE iYPEO LONSi.AC70At OCwPervcr HOarow¢uxGuxns � <br /> GPOUP <br /> /_� _3 PLUh18iNG <br /> SIZEOFBLDG NO.OFSTOflIES BASEMENi MECHANICAI <br /> 3�8H sa -F <br /> 87P sf c,1a. Z `.] YES X NO �/ � �1I/ / <br /> OGCUPANCfLOAD FIFESPfiNKLER5RE0'� HEIuHT�IMIT�ION OTHER r. /�'/ /? l I/ _ �� ; `'/ <br /> � J{ f�� YES X NO Za t�� <br /> STATE UILDING SURCHARGE <br /> REh50N FOF SPRINN�ERS <br /> STATEENERGVSURCHaRGE ; <br /> APPLICATIO AGC.BY PLANSAPP�EDBY CITY OF EVEflETT PUBLIC WORK$ ' � <br /> �,, LOCAL SALES <br /> TAX COOEIS 3105 TOTAL <br /> ll�,(p <br />