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J `.. .... _ _._J-.�.. ...+.. . � . ' . . . . . . . . .. . ....._� .__.•.. . . ........... . . ' . . ..��1� . rc.���...� <br /> APPLYCATIOr� FOR CONSTRUCT�.;�N PERMIT everett ' <br /> tne Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> arv oF <br /> eve rett HEATING SYSTEM: GAS ❑ELECTRIC ❑ � <br /> BUILDiNG DEPARTMENT ' I <br /> 259-8810 ! I <br /> 17 DEbSOUTION I I COMBINATION I ! BilILDING � �MECHANICAL Ll PLUMBING I J SIGN ; , <br /> 1 IL AO�RE55 CITY ZIP� P ONE � r � , '��. <br /> � ���.�ly . �h� � ����`e�`p� ! ' <br /> 1 - �j <br /> TEN MRII.A RESS CITY ZIP PHONE �s�....� �O--��� � <br /> �T V� <br /> ARCIIIiELTOFDESIGNEF MAILAD�flESS CITY ZIP PHONE � '. <br /> P <br /> CI7Y //-- ZIP �x(.� PIIONE LICENSE N � <br /> � GENE 1 ACTOfl All E55 _ �/� � � CIT/� I� ��ZIJ � U �/NE�% LICENSEX ' <br /> (�IL I V C... <br /> M CHANIGALCON RC R MAILAODRESS <br /> PWMBINGCONTRACTOR MAILAUONESS GTV ZIP PIIONE IICENSEM � <br /> �I <br /> P, � � �I <br /> f,LA55OF WOflK <br /> j11 NEW f�l ADDITION �7F AFI01C� i '' REPAIR I I DEMOLITION I I WUODSTOV6FRPLINSERT I i BUILDINGRELOCATION i <br /> ' -- JJJ---���(((��� �/� LONTACT PERSON ANO PHONE NO. �' , <br /> �p;y7qpf,'f PRICE OF WORK I�'�"� ,� ' <br /> OESGMIBE OHNAN 5 �REFOOTAGEINVOIVED� p�\� i� � <br /> u i� -Ti I <br /> �POSEDUSEOFBU rt+c 1 I HEREBY CEfiTIFY THAT 1 HAVE READ AND EXAMINED THIS �. <br /> � \ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL f: <br /> LEGRL DESCRIPTION OF PROPERN ISHOWN BELON OR ATTACM FOUR COPIES� PROVISIONS OF LAWS AND OfiDINANCES GOVERNING THIS TYPE OF � <br /> WORK WILL BF COMPLETED WITH WHE7FIER SPECIFIED HEREIN OR i <br /> �or BLOCK oF NOT. THE GRANTING OF A PERMIT DCES NOT PRESUME TO GIVE + <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY {. <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE i <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br />- OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH l. <br />� APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br />• CONTRACTORS LAW 18.27 RCW AND 296200 WAC. � <br /> SIGN�TIIREOFGONTflACTOROFAl1THORIZEDAGENT DATE , <br /> Y <br />> ��u�� S ' � �'���— ; . <br /> y�; YHQIEC REuS /,^ `� C pppLICANTS LITV BUS�N�SS LICENSE NO.AND BUSMESS NAME ' <br />� . 1� " � f���Q .P- 7 �� <br />�. <br /> PLUMBING MECHANICAL <br /> c�..� Np, TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br />�'���� WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. ' <br />�i5� BATHTUB ' FORCED AIR S`!STEMS—B.LU. E.A. ' <br />�'.� — LAVATORY(WASH BASIN) ; UNIT HEATEFiS—B.T.U. M � . <br /> CLOTHES DRYERS ' ::i' <br /> SHOWER � ..� <br /> ' VENTILATION PAN � - = <br /> KITCHEN SINK 8 DISP � . <br /> — RANGE HOOD ' 'ST�,��S <br /> DISHWASHER ' , k•;} <br />�� — � WATER HEATEF ' '�:; <br /> LAUNDRY TRAY � � •.- <br /> CLOTHES WASHEfl � WOOD STOVE ' � i^ <br /> — � METAL FIREPLACE 8 CHIMNEY ' <br /> URINAL � <br />`. DRINKWG FOUNTAIN I FIREPLACE INSERT � � <br /> � HEAT PUMP ' �� <br /> '� �FLOORDRAIN - i , ; <br /> ��.� �BACKFLOW PAEVENTERS ' GAS PIPING � <br /> � <br /> RUOF DRAINS—RAINLEADERS �—�— E%HAUST FAN ' � <br />; — i <br /> R��-��` �INK(S�RVICE—BAR,ETC.) I � ' <br /> � <br /> - —�— <br /> _ , <br /> I.' � � <br /> — � � <br /> � �, <br /> i � <br /> SUBTOTAI $ ' SUBTOTAL $ _GIO 'Da � <br /> PERMIT $ � PERMIT $ !.c' ��� <br />''��� � TOTAL FEE $ ' TOTAL FEE $ S' `'�' <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO. <br /> FflONT SETBAGK flEAR SETBAGK SI�E SETBACK PLAN CHECN NUMBEfl FEE , <br /> USEZONE LOTAFEA VACANTSITE FEES VALUATION FEE � <br /> i <br /> BNLDING ' <br /> TYPEOFCON75.AlLOJ/PBIE 7YCEOfCONSi.Af,IWI attuPAHtr xOofoWuuNGwinS i j�. <br /> eeouc pLUMBING � <br /> i <br /> SIZEOFCLUG. NO.OFSTORIES BASEMENT MECHANICAL SSi�O �- <br /> — i i. <br /> i <br /> AODiTIONALPI.ANCHEGK � i��. <br /> OCCUPANCY LOAD FIPE SPRNKLERS REO'0 NEIGIR LIMITFTION �. <br /> OTHER i � <br /> F <br /> PEASON FOfl SPflINNLERS � <br /> STATE BUIIDING SURCHARGE � �� <br /> r <br /> � <br /> INTANE OY PLr1NS APPROVEO BY CITY OF EVERETT PUBLIC WOflKS i <br /> LOCAL SALES � �p J ` <br /> TAX CODEIS 3105 TOTAL <br /> ------__ I --- � <br />