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� � <br /> APPLICATI�..I FOR CONSTRUC7 .JN PERMIT everett <br /> fhe Evergreen TQ BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> .everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUIIDING DEPARTMENT <br /> 259-8810 <br /> O DEMOUTION ❑ COMBINATION ❑ BUILDING L MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �%�croR �. AN4eRSe�RE�/�jbzY SoROn✓a�SmAR[�wy•to.�'P �J8223 PHONE Y3S- �J237 <br /> TAMPS L. Auneksew! �i� 1 [omftnn�j' E�e,e��i 98z� � �5 Z -25�/ <br /> TEN�NT MRILADDRE55 CITY ZIP PHONE <br /> ARCNITECTORDESIGNER MRILAUDFE55 CITV 21P PHONE <br /> ���,�oor zood zs�z �o�a�� e�eRert 9�ao � asa - 693Z <br /> � GENER�LC iMCTOR MAILA�DHE55 r CITY ZIP PHONE LICENSEI <br /> �/icToR �. AuD�tse,u �54ZV SoRAAN Rd ARL��ro,v g3Zt3 y3S-9�3� �ICTODA IZ3LZ <br /> MECHANICQCONTRACTOfl MAILADOFESS CITY 21P PHONE 'NBEMB[� <br /> �' IT-i oFf�e,aU7—oo8 �19 <br /> � PLUMBINGCONTRACTOR MAfLADDRESS CITY ZIP PHONE LICENSE� <br /> . . CUSS OF WORN��� <br /> ❑ NEW L�I ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL INSERT C BUILDING RELOCATION <br /> ' CONTACT PEfl50N AND PHONE NO. <br /> � CONTMCT PRICE OF WORK �D O O � 1 G D. <br /> � DESC I WOflKANDSOWREFOOTAGEIN VED <br /> A��cnaPotir ro x �sr�Ny oup«x sy - y3S- `�Z 3 � <br /> � � PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> 5 E'X i s r�N� D u�Lex CA R T APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl � <br /> � � LE6ALDESCRIPTIONOFPROPERTY(SHOWNBELOWORRTfACHFOUFiCOPIES) PROVISIONSOFLAWSANDORDINANCESGUVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � � i �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO CaIVE <br /> �� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � - � � OTHEFi STATE OR LQCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �. OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE P:JD I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B.?��iCW AND 296200 WAC. <br /> � <br /> S1uNANREOFCONTMCTOROPAUTHOFIZEDAGENT DATE <br /> 1 PROJECTADORESS �}- � �� � <br /> � �Z �� Z �'� S / • � EVCRe ,I�- APPLICANTSCITYBUSINESSUCENSENO.MIUBUSINESSNNAE <br /> I GC, <br /> PWMBIN6 MECHANICAL <br /> N0. TYPE OF flXTUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � NC—A/HNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN)� � UNIT HEATERS—B.T.U. M � � ���. <br /> �, <br /> SHOWER ' CLOTHES DRYERS ' � . <br /> KITCHEN SINK&DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � . � <br /> LAUNDRY TRAY ; WATER HEATER ' � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> � DRWKING FOUNTAIN I FIREPLACE INSERT I <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � ' <br /> i ' <br /> � ' <br /> � ' <br /> — � � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK flERR5ET8AGK SIDESETBACH PUNCHECKNU�BER FEE � J RECEIPTNO./ <br /> 2O, ,�' � 7r� 4C <br /> usezorre LOTAREMA vncnr+rsire FEES VALUATION FEE <br /> R�2 ��+�/ � n BUILDING �59 ' <br /> 7YPEOFCONTS.pILOWABtE 1YPEOFCONST.RC10pl acuvu�Cv xo.Mow[uixGUNrts � <br /> �Ap�P Z PLUMBING � <br /> i / � 1 <br /> SIZE OF BLDG. NO.OF STORIES BRSEMENT MECHANICAL � <br /> JCCUPANCV LOAD FIRE SPRNKLERS REO'D HEIGHT LIMOITATION ADDITIONAL PLA H CK �J�T O <br /> CI � <br /> /�(J Z'b OTHER i <br /> FEASON FiSPRINNLERS ' � <br /> STATE BUILDING SURCHARGE � <br /> i <br /> INTRKE BV PLANS APPROVEO BY CITY OF EYENETT PUBLIC WORKS i <br /> 9 LOCALSALES � <br /> � 5�/y TAX CODE IS 3105 TOTAL Q ; <br />