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� �. - <br /> APPLICAT10.�1 FOR CONSTRUCT a�N PERMIT <br /> everett <br /> the Evergreen e <br /> CIiV OF 1 <br /> ��� everett ', <br /> BUILDING DEPARTMENT <br /> � H 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT i <br /> �H�i cn ' C l DEMOLITION ! COMBINATION BUILDING MECHANICAL PLUMBIkG SIGN <br /> �`, S OWNER / � MAILAD�FE55 p� CI ZIP PHON[ <br /> I F•i .j,/I�v,Pl�/r.-'t/J /-�'j/ 7r i�U1�LlGffs �/�f�/Zc� ��� `�G � — '/P� � <br /> ��� ENANT MAIL AOORESS CTY ZIP PMONE – � <br /> f9 �s, � /G7 30 /r7 �r S�E ,.t �—��.:� ��:Z�'� �� <br /> �� ,%�lf�"r C f� Jc� � ; <br /> y ARCNITEGTORDESIGNER , bAILAD�RE55 CITV ZIP PHONE <br /> �xo — <br /> �] GENERALCONiRALTOR MAIL �DRESS � CITY ZiP / PHONE LICENSEv � <br /> � og ��2�, �4�r-�<�a��� a��� �t�S�rf�� 5.� /�e!/�.�F c :��c 4 <br /> ��� IdEGH hICAL NTRACTOF MAILAD�PE55 CITY 21P PHON[ LICENSEk I <br /> � <br /> xyy� PL/UM�BINGCONTRACTOR MAILAOnORE55/ CITY 'ZiP .�! PHONE IICENSEM <br /> r�.,� //�P� �i c�[� 1��ltn ���� P.Tr'l-��i /�t Y�,�ru/ �StLD/ 1S�-7SR�' /�''cKyS/�/�S'Jl3 <br /> CLASS OF'NONN <br /> ��y , NEW '..�: ADDITION . �I ALTERATION � REPAIR DEMOLITION ' � WOODSTOVEiFRPL INSERT '. ! BUILDING flELCCATION <br /> � � TEN I POVEIdENTORINTERIORRElAOOELONLY C@1iACTPER50NANDPMONENO. � <br /> �w COtlTRACTPqICEOF\VORK: <br /> y DESGRIBEWOPKANDSOUAREFOOTAGEINVOLVED <br /> PROPOSEDUSEOFBUIL��NG I HEREBY C[RTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> . APPLICATION AND KNOW THE S�1ME TO BE TqUE AND CORRECT.�LL <br /> LEGALOESCRIPiIONOFPFOPEFTY�SHOWNBELOWOR�TiACMFOURLOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNIN�THISTVPEOF � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br /> �or eiacK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AI:Y <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 /> ���'t•'� •!"�" �j�^'�°�"�— APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �I��y� �� �f t//3 SIGN�T�REOFCONTFACIOFORAUTHORRE�AGENT OATE <br /> �Y� i <br /> - /�� .s. �-� <br /> PqQIECTApDRE55 y����i�'�<<� �//Lf-����� .. <br /> '_' APPLIC�NiS LiiY BUSINE55 LICENS[NO.ANp BUSINE55 NAAIE <br /> ' ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> / WATER CLOSET(TOILET) >�I � NC—AIHNDLG UNITS—H.P. i <br /> '�' BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> 'Y LAVATORY(WASH BASIN) 'Lr � UNIT HEATERS—B.T.U. M ' <br /> '�I SHOWER CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP VENTILATION FAN � <br /> 1 DISHWASHER RANGE HOOD <br /> ' LAUNDFYTRAY / WATERHEATER <br /> / CLOTHES WASHER :3! WOODSTOVE <br /> �' URINAL ; METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> f FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> �1 ROOF DRAINS—P.AINLEADERS E%HAUST FAN <br /> � / SINK(SEflVICE—BAR,ETC.) /y/o /> <br /> 1_ , <br /> 1 <br /> ' _ SUB TOTAL 5 SUB TOTAL $ <br /> PERMIT 5 PERMIT 5 �C <br /> —��--- TOTAL FEE $ �; TOT�L FEE S I ' <br /> FRONiSETBFCK �EMSLTBACK SIDESEi�AGN PLANCHECNNUM1IOEP PL[ RECEIPTNO. <br /> usezor+e IOTAFlER vacnNTsire °EES VALUATION FEE <br /> . VES . NO BUIL�ING <br /> iYPEOFGOflSiALLaWABIE iYPEOFWNSIACICAI OCCLrR�sv !:onfhNnruGul.nS <br /> 'SO`� PLUMBING �J i <br /> SIZEOFBL�G. NO.OFSTOPIES �ASEME`!T MECHANICAL �. I �SU <br /> YES NO <br /> OCCUPANCYLORD FIHESPPNNLERSREOD HEIGHTIIMITATiON OiHER <br /> . �. VES I NO S7ATEBUILDINGSURCHARGE <br /> RE�SON FOP SPR�NNLERS —�— <br /> STATEENERGVSURCHARGE <br /> APPIIL�TIONACG.BY PLANSAPPROVEDBY CITYOFEVERE7T Pl1BLICWORN$ <br /> LOCALSALES <br /> fAX COOE IS 3105 TOTAL 5� �J� • <br />