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APFLICATIO� FOR CONSTRUCT JN PERMIT <br />the everyreen TO BE COMPLETED IN INK—PLEASE PRINT <br />cin oF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION COMBINATION BUILDING MECHANICAL ❑ PLUMBING <br />everett <br />e <br />�-: SIGN <br />pWNER FIFILAODRESS CITY nr rn��.c <br />SCb� yaf�/72/C/f.LiCYG f�i'Lf.r..�✓ .���G ��/�� Sf- �(/� u//)- b'.Loi nZ.S`.Sl4�Y3 <br />TENANT MAILAODRESS CIiV ZIP PHONE <br />%%��.Z �K/'l'�sS .S�L.–�(= <br />pPf.HITECTORDESIGNER MAILAOURE55 CI1V ZIF FHONE <br />GENERALCONTRACTOR MAIIADDRESS CIN ZIP PHONE LICENSEN <br />MECNANICALCONTRPCTOR MAIIAUURE55D /�E-� CI7Y ZIP PNONE UCENSEI <br />��d0�%t .�/ /G ,' S L,' sf ,�v <tiit 9 S1.�d / .�S 8 i �"�s <br />PLUMBING CONTRAf.TOR M�IL ADDRESS CITV 21P PHONE LICENSE a <br />CLASS OF WONK <br />❑ NEW D� ADDITION i l ALTERATION :.. REPAIR .�' DEMOLITION ._� WOODSTOVE/FRPL INSERT 'u BUILGING RELOCATION <br />�ONTACT PERSON AND P/IONE N0. <br />�✓ <br />CONTRACTPRICEOFWORK /�OO <br />�ESCFIBE WORN AND SOl1ARE FOOTAGE INVOLVED <br />USE OF BUILDING <br />LEGAL DESCBIPTION OF PROPERTY (SHOWN BELOW OH RTTACH FOUR COPIES) <br />wr__ e�ocK 3 r Y oF �� �� <br />� �_.. � B_ 'L� 7 c � � � ,� <br />� PRUECT ADDRESS <br />a i�6 i� ��` <br />PLUMBING <br />NO. TYPE OF FIXTURE O <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADE <br />SINK (SERVICE—BAR, ETC.; <br />FOR OFFICE USE ONLY: <br />canNTSFTBACK REARSETBACK <br />USEZONE <br />iVPE OF CON15. ALLOWABIE <br />SIZE OF OIOG. <br />OCCUPANCVLOAD <br />AEASON FOP SPR�NKLERS <br />INTAKE OV <br />95f.�v/ <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ P,ND FXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCF.S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTI�'G OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUREOFCONTRACTORGRAUTHORIZEOAGENT DATE /3'/`I�%/ <br />X S !r� � �-, <br />APPLICANTSCITVBUSINESSII� NSENO.ANDBl151NESSNAME <br />MECHANICAL <br />JO. TYPE OF E�UIPMENT FEE <br />� <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />; WATER HEATER <br />WOOD STOVE <br />' METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />SUB TOTAL 5 ' <br />PERMIT $ <br />TOTAL FEE $ <br />SIDE SEiBACK <br />VACANT SITE <br />CONST ACiUAL <br />NO. OP STORIES <br />FIRE SPRNKLERS FEO'D <br />PLP.NSAPPROVE <br />J �''`r <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 3 :S U ' — <br />PERMIT 5 /S � — <br />TOTALFEE $ �/Sr <br />PLANCHECKNUMBER I FEE � �ECEIPTNO. <br />BUILDING <br />OCCIICAYLY NO OfOWEll�11L1iW15 <br />�POp° PLUMBWG <br />BnSEMENi MECHANICAL <br />HEIGHTLIlAI7ATION ADDITIONALPLANChFCK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBL.IC WORNS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />0 <br />