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APPLICA7 _�N FOR CONSTRU�:�r10N PERMIT <br /> everett <br /> . ' the Evergreen <br />�;�,, cin oF <br /> ` � everett e <br /> ;e. <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> ;'. � 259-8810 . <br /> F� - ❑ DEMOLITION I I COMBINATION I I BUILDING ��ECHANICAL I I PLUMBING I_l SIGN <br /> ' i <br /> ' . O�YNER MAILAUDRESS CI7V 7.IP PIIONE <br /> r L„� �l�a���4 �tiSL� 'Lotu •- Z� sr ��i ?r�- iL <il <br /> -- TENANT MAILA�DRE55 :ITY ZIP PHONE <br /> ns"; <br /> - �i <br /> � ARCHITECTOROESIGNER M�ILADDRESS CIiV 21P PHONE <br /> a1 <br /> �:_. � _. <br />��' GENERALCONTNACTOR MPILAOORESS CRY 21P PHONE LICENSEN <br />�: <br /> - �u MECHANICALCO TflACTOH MFILADD(iE55 CITV ZIP PNONE LICENSEI <br />����� � 3 ��� �+,�k ��r 5vz � � zc5�c3a� No•�r-wl, i37 r�r <br /> /U.W U4 �r U. ''�' c �IJ -�� <br /> -.�y i <br /> PLUMBINGCONTpACTOR MAILAD�RE55 CIIY 21P VHONE IICENSER <br /> f <br /> '. � CLASSOFWORK �/ <br /> � � I ❑ NEW Ll ADDITION I/r ALTEFATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSEfiT I 1 BUILDING RELOCATION <br />��: <br /> TEN�NT IMPROVEMENT OR INTEFIO��7p0 ON�Y CONIACi PEf150N�ND PIIONE NO. <br />�,'�� CONTRACTPRICEOFWOFN: �a� <br /> 2:::' , ' _ <br /> jj'{..:: i DESCRIBE WORK AND SOUFflE FOOTAGE INVOLVED <br />�" f�u tf <br /> ; r✓s,n,.� �.�: <br />��._„ i PqOPOSEDUSfOFBWL0ING n I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> i�� � �L� I,,� Af?LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br />"�'° PHOVISIONS UF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I LEOAL DESf^.IP ION OF PPOPEf1TY�SHOW BELOW OR ATTACN FOUR COPIES� <br /> � V�ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ' f �or e�ocK oF PlOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> f-ll� � I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />�y.;,(; I 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 296.200 WAC. <br /> ' � <br />�1�.�, SIGNATUREOFCONI(14piOROfiAUIHOiiIZEDAGENT DATE <br />�' ' ( _ � <br />�1 � �J <br />(�; t . IC G''t-' N � / <br />�-.� � PpOJECTADDRE55 '7 — 1 <br /> � 'O I U ' �J� cv/ ' A�PLIC�NIS CITY 9USINES$LIC NSE NO.AN�BUSINESS NAME <br />�~��� � MECHANICAL � <br /> PLUMBING <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOIIIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—�i.R � <br /> BATHTUB ; FORCED NIR SYSTEMS—B.I.U. M E.A. ' <br /> ' LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> ' KITCHEN SINK 8 OISP I VENTILATION FAN � <br /> �� 91SHWASHER RANGE HOOD � <br /> � LAUNDRYTRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE 8 GHIMNEY ' <br /> � DR�NKING FOUNTAIN � FIREPLACE INSERT __� <br /> FLCJR DRAIN � HEAT PUMP ' <br /> � bACKFLOW PREVENTERS i GAS PIPING i <br /> - ROOF DRAINS--RAINLEAOERS � EXHAUST FAN _ � <br /> SINK(SERVICE—BAH,ETC.) � _ � <br /> � <br /> � � <br /> —� <br /> , — � <br /> -- � j <br /> � — � I <br /> ; — � <br /> SUB TOTAL $ ; SUB TOTAL $ / ' J �'�, <br /> PERMIT $ � PEHMIT $ i i ` I <br /> —r— <br /> TOTAL FEE $ ' TOTAL FEE $ 3✓ ' —' I . <br /> FRONTSETflRCI( REAFSFTAACK SIOESE7B�CH PLANCIIECNNUMBER FEE FECEIPTNO. <br /> use zorve lOT AREA VACANi SITE FEES VALUATION FEE , <br /> I.I VES IJ NO BUILDING ' ' <br /> iYPEOFCaNSi.ALLOWABIE 1YPEOFLONSI.AC7UAL occurexcr NOOfIM'FLLIN60ni15 � � <br /> tnour PLUMBING i � � <br /> i I `i <br /> SREOFBLDG. NO.OFSTORIES BASEMENT MECHANIJAL 30 � � ' -'d� <br /> I I YES I I NO � . ���?q <br /> OCGUPANCYLOAD FIRESPRNNIERSREO'0 ��EIGHiLIMRA�ION �T��r'� � � ` <br /> � <br /> I.l YES I I NO S7ATE Bl11LDING SURCHMGF ' � <br /> i <br /> flEA50N FOR SPRINKLERS i � <br /> STATE ENERGY SURCHARGE � <br /> APPLICATIONACC.BY PLANSAPPROVEOBV CITYOFEVERETT PUdLICWORN$ � � <br /> LOCALSALES � <br /> TAX COUE IS 3105 T�TAL 3 e I <br /> i <br /> : �-,.-.�r.;,:-... _ _ � <br />