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,� <br />�APPLICATIO.J FOR CONSTRUCTrON PERMIT �verett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />fhe Evergreen <br />qTV OF <br />everett HEATING SYSTEM: � GAS ❑ ELECTRIG ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ! � COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEfl � M�ILAODRESS CITV ZIP PHONE <br />1.ou zclg�l�C N9�5-33Ao ar/ �'v�,eETT 3yrs�sZ <br />TENANT MAILADDRE55 CITV ZIP PHONE <br />AFCMITECT OH DESIGNEP MAIL FDDflE55 CITY 21P PNONE <br />GENEflAICONTMCTOP MRILADDRE55 CI7V ZIP PHONE �ICENSE� <br />MECNANICQCONTMCTOfl MAILADDRESS ._ CITV ZIP � PHONE LICENSEI <br />Trf�Hs,�hF-rr �aSuN�F��lw��v,r/��cc� wy urefloi.�ur« w� 9��L �-�5�3 <br />P�UMBINGCANTRACTOR MAIL�DDRE55 CIN ZIP PHONE LICENSEt <br />CLASS OF WOPK <br />❑ NEW ❑ ADDITION �ALTERATION <br />DESCRIBE WIXiKANO SOU�RE FOOTAGE INVq.VED <br />LEGM. DESCN�PTION OF PROPERTY �SHOWN BELOW OF ATTACH <br />LOT BLOCK OF <br />PROJECT <br />I �V <br />�. <br />TYPE OF <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�FAINLEADERS <br />FOR OFFICE USE ONLY: <br />FROhTSE7BACK REARSETBACK <br />VSEZONE <br />TYPE OF LONTS. AILOWABLI <br />SIZE OF BLDG. <br />OCCUPANCVLOAD <br />REASON FOR SPFINKLE <br />INTAKE BV <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />7YPE OF C�NST. ACTOAL <br />NO.OF STOHIES <br />FIRE SPRNKLERS REC <br />PLANS APPROVED BY <br />SIDE SETBACK <br />YACANT SITE <br />I HEREBY CERTIFY THAT I HAVE READ ANG EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND COtiRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WFfETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFiOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 2%200 WAC. <br />SIGNATUHEOFCONTMCTOCORAUTHOiiIZEOAGENT DATE <br />X l9 ���� � /i -93 <br />�PPLICAMS CITV BUSINESS LICENSE NO. AND BUSINE55 NAME <br />NO. I TYPE OF EOUIPMENT � FEE <br />A/C—A;HNDLG UNITS—H.P. <br />FORCED AIR S`!STEMS—B.T.U./ M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS _ <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PUN CMECK NUMBER _ � FEE <br />BUILDING <br />acooencr xa orow[�uxcuxrts <br />�w�P PLUMBING <br />BASEMENT MECHANICAL <br />HEIGN7 LIMi7A7iON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORNS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />Mp <br />n <br />