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� . <br /> APPLICATIt�A FOR CONSTRUCI .ON PERMIT <br /> everett <br /> the Evergreen � <br /> CIN OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN IPJK—PLEASE PRINT <br /> ❑ DEMOLITION L I COMBINATION ✓ BUILDING `�MECHANICAL �PLUMBING -: SIGN <br /> OW��ER MAIIA��RESS CITY ZIP PHONE . <br /> � -�. � CeLE IS)3 Ih�..K��.T-� M4K.w-'�� 982iS 3��-03TKlt �RT-L`{}�. �.J <br /> TENANT MAILA��RESS CITY ZIP PMONE <br /> �\ � � <br /> ARCHITECTORDESIGNEF MAILADORESS CITV ZIP PHONE <br /> G�c.a w E��s P.o. L�ax ��� Lck,�-, 9$so3 3SZ -�/�S3 <br />� GEN pLC NTRACTO MHILADDRESS CITV 21P PHONE UCENSER <br /> �nc�tnwt �cMasw-,�.,.-L-t <br /> � <br /> MEr,HANICALCONTqACTOq AILAOORE55 CITY ZIP PHONE LICENSEx <br /> �asa.-c�:e. I oat S. l�ac�.s O�-�,.�c�a 9&50� g w3 -Zrsz <br /> PLUMBINGCONTflACTOR MAILADDRE55 CITY 21P PHONE LICENSEa <br /> CLASS OF WORK <br /> �NEW ❑ ADDITION '. ! ALTERATION ._! REPAIR �._�: DEMOLITION ; �. WOODSTOVE/FRPL INSERT : ! BUILDING RELOCATION <br /> TENANT IMPflOVEMENT OR INTERIOR PEMO�EL ONLY CONTACT PERSON ANO PHONE NO. (' <br /> CONiP0.CT PRICE OF WORK: 6�O �,�� G / 7 � <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br /> 6"�oa-y <br /> PROPOSEDUSEOFBUILDI c I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS , <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRIPTIONOFPflOPEPN�SHOWNBELOWORATTACMFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNWGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or_� e�ocK oF NOT. THE GRAN�-1NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STAT[OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM RUTHORI2ED 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 296200 WAC. <br /> SIGNATUREOFCONTR�CTOFORAUTHORIZEDA�ENT �ATE <br /> PROJECTADDRESS � � <br /> � X / A �.�i �� f,E APPLICANTS CITV 9USME LI NSE NO.AND BUS�NE55 NAME <br /> / <br /> . PLUMBING tAECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE . <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR S`lSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS ' <br />� KITCHEN SINK 8 DISP � VENTILRTION FAN � <br /> DISHWASHER � FANGE HOOD � <br /> LAUNORY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER WOOL�STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br />� SINK(SERVICE—BAR,ETC.) I � <br /> � <br /> i ' <br /> � � <br />' SUB TOTAL 5 I SUB TOTAL $ ; <br /> PERMIT 5 � PERMIT $ � <br />, TOTALFEE $ ' TOTALfEE S ' <br /> FRONT SETBACK � REAR SETB K SI�E SETBACK PL4N CMECK NUMBER FEE RECEIPT NO. <br /> ,r o �/ �'7 0. G P 33 � <br /> usezoNe z LOTA E-q7 y//� VACANTSITE FEES VALUATION FEE <br />� ��Z;J �/ ��D `� "- YES ���� NO BUILDING �Q �- � '� <br /> TVPEOFCONST LLOWABIE NPEOFCONSiATOAt ot[uanxtv coOtOwEluti6uw�5 � <br /> �/_� 1/_ � p_�P PLUMBING i <br /> V <br /> SIZEOFBLDG � NO.OFSTORIES BASEMENT MECHANICAL � <br /> 5 g ° / _� ves : No <br /> OCCUPANCVLOAD FIFESPPNNLERSREO'D NEIGNTLIMITATION OTHER <br /> �� fJ YES J� NO L� O � STATEB ILDINGSUFCHARGE i5O <br /> REASON FOR SPRINKLERS <br /> STATEENERGVSURCHARGE i <br /> #PPCICMf9N#B6-BV� pLA pPPROVEDBY CITY OF EVERETT PUBLIC WORKS � <br /> 1„ }�kP LOCAL SALES � �� <br /> / 'f�� �}' TAX CODE IS 3105 rorn� <br />