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,. . . <br />APPLICATIO�� FOR CONSTRUCTI.�1N PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />1he Evergreen <br />CIN OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION ', COMBINATION ; BUILC{�!G f_ MECHANICAL ' 1 PLUMBING SIGN <br />OWNER MAIIADDRESS CITV ZI' PHONE <br />,�,�iQdi�U �FiQLO {�' %"foi �� 9UF SE 9�So s O� u�O i- Y3� 6�-?,i 9_ <br />TENRNT MAII ADDRE55 GTV ZIP PMO <br />ARCHITECTORDESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERALCONTRACTOR MAILADDRESS QTY ZIP PHONE LICENSEI <br />MECHANICAL CONTRACTCR MAIL ADDRE55 CITY ZIP PHONE LICENSE s <br />PLUMBING CONTRACTOR MAIL RDDPESS CITY ZIP PHONE LICENSE! <br />CLASSOF WORK <br />;; NEW i.. ADDITION ❑ ALTERATION �: REPAIR J DEMOLITION J WOODSTOVE/FRPL INSERT Ci BUILDING RELCCATION <br />p CONTACTPERSONANOPHONENO. <br />CONTRALTPRICEOF WORK �S � ��O� /S�'OX� __ <br />DESCRIBEWORNANDSOUAFjEF¢0T�1G§�HVO��E� �y�Q'1�,I{� ��y�V� <br />• n f'4h.1. 31JJ.�r� as V <br />l� Cf3�9blS) �._,�T'- iY/-�i�1'�X > �O � 1�9� <br />Pao SEDUSEOFBUIL�ING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�FS�OENCE � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTV (SMOWN BELOW OR ATTRCH FOUR CAPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�or BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANY <br />OTHE LOCAL LAW REGULATING CONSTRUCTION OR THE <br />P ORM� ONSTRUCTION. TL���RIZED THE <br />OWNER OF THIS P EflFORM W K FO HICH <br />ApP TIO ADE AND O LY W H T STATE <br />�CONTF RS LAW 18.27 R� ANp 2 00 W <br />��� <br />NO. TYPE Of FIl <br />% WATER CLOSET(TC <br />BATHTUB <br />� LAVATORY�WASHE <br />SHOWER <br />KITCHEN SINK & DI; <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA <br />FLOOR DRAIN <br />;�� <br />�� <br />NO. AND <br />FEE � NO. / TYPE OF EQUIPMENT <br />S', pb A/C—FVHNOLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M <br />�Op UNITHEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />flANCaE HOOD <br />; WATER HEATER <br />, WOOD STOVE <br />� METAL FIREPLACE 8 CHIMNEY <br />; FIREPLACE INSERT <br />HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />SUB TOTAL $ ! .� � [ <br />PERMIT $ � v <br />TOTAL FEE $ d—J� o <br />FOR OFFICE USE ONLY: <br />�RONT SETBACK REAR SETBACK <br />USEZONE LOTAREA <br />lYPEOFCONiS.ALLOWABIE NPEOiCONSi.ACTUAL <br />SIZE OF BIDG. NO. OF STORIES <br />OCCUPANCYLOAD FIRESPRNNLERSREC <br />REASON FOF SPRINKLERS <br />INTAKE BY PlANS APPROVED BV <br />SIDE SETORCK <br />PLANCHECN <br />BUILDING <br />occuvAxcr xa orow[wxcuxrts <br />�AWP PLUMBING <br />BnSEMENi MECHANICAL <br />MEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />CITY OF EUERETT PUBLIC WOFiKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />70TAL FEE $ <br />NO <br />� <br />� <br />