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APPLICATIOrI FpR CONSTRUCT�JIN PERMIT <br /> () ��(�'� everett <br /> Ihe Evergreen � <br /> CITY OF � <br /> everett <br /> BUILDING DEPAHTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> �_! DEM�JLITION �: COMDINATIUN �' BUILDING � MECHANICAL -' PLUMBING '-: SIGN <br /> GEr�VGI`()NO / /'�/r��p5R1Wl �(�i• S�6o6 � QCn'1nvL�.S� ���/L�; �7� PHONE � :7 �—�G �� <br /> TENANT MAILAD�PESS GITV ZIP PMONE <br /> ARCHITECTORDESIGNER MAILAD�RE55 CIi" ZIP PHONE <br /> �✓��./S Ac.II GuF—.>f <br /> GENERALCONiRAGTOR MAILAODRLSS CITY ZIP PXONE UCENSEk <br /> �l� ��la��i f.r�r1Y L13Lhiirit� gy' 6V!%�(7' 1�-i} �I��� LS� -9ySL /U/!C/l� ��V23Uo% <br /> MECHANICAL CONTRAGTOR MAIL P�DRESS CITV T ZIP PHONE LICENSE a <br /> PLNABING CONTRAC70R MAIL AD�FE55 CITV ZIP PHONE IICENSE M <br /> CLASS OF WOPK <br /> �-I NEW KADDITION C ALTERAT�ON �� REPAIR -! DEMOLITION !��'� WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOP REMO�ONLY CONTACT PER�cN AND PHONE�O. <br /> WNTRACT PRICEOF WORK: ��\ J .ni �/�ur 2 5 L--� ySo <br /> DESCPIBE WORK AND SOUARE FOOTAGE INVCLVE� <br /> 3�4SY (-rnnoinvN I��lUl�r >�+6o <br /> PROPOSEDUSEOFBllIL01NG I HEREBY CEP.TIFY THAT I HAVE READ AND EXAMINED THIS <br /> � . � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ' S f�� ' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCFIPTIONOFPROPERTY�SHOWNBELOWORATTACHFOURCOPIES) �pJOPK WILL 6E COMF�LETED WITH WHETFIER SFECIFIEU HEREIN OR <br /> �oT�_ Bi�K oF S 4 NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> MDU F��'�N V EL� R A� OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION 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 /> SIGNATUREOPCONTRACTOROR.111THORIZEDAGENT DATE <br /> X -� � <br /> ..� %��v� <br /> PROJELT AODRESS ppp� pNTS CITY BUSINESS LICENSE NO.ANO BbSMFSS NAME <br /> 8��6- � � �'�� � 1. �=, <br /> PLUMBING MECHANICAL <br /> Np, TYPE QF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLUScT(TOILET) � AIC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> IAVATORY(W4SH BASIN) � _ UNIT HEATERS—B.T.U. M �_ <br /> SHOWER ' CLOTHES DRYERS _� <br /> KiTCHEN SINK&DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> 1 LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHEF � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN NEAT PUMP <br /> BACKFLOW PflEVENTERS ; _ GAS PIPID:G � <br /> ROOF DRAINS—RAINLEADERS � EXHAUS�FAN ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> —�— <br /> i ' <br /> � ' <br /> SUB TOTAL 5 i SUB TOTAL S <br /> PERMIT $ PERMIT S � <br /> TOTAL FEE S TOTAL FEE $ ' <br /> REAR SETBACK SIDE S[TBACK PLAN CHECK NUMB R FEE L��! RECEIP NO <br /> FRONT SETBAC� � � � � J ✓ �O/� <br /> usezor+ LOTAREA VACANISITE FEES VALUATION FEE <br /> p C 1'ES �NO � <br /> �–� U �` BUIL�ING Z 0 � <br /> TYPEOGCONSi AIIOWABLE 11'FEOFC N5T ACiUAL IX[uva4cr nOAimvluxGUNuS � <br /> �. p �� 1 �°�3 PLUMBING <br /> /V N � <br /> SI2E OF BLDG. NO.OF STCPIES BASEMENT MECHANICAL � <br /> S' ❑ YES x NO ; <br /> OCCUPANLY LOAD FIRE^uPFNKLERwS/REO'0 HEIGMT LIMITATION �THER /j <br /> N L� YES /�NO STATE BUILDING SURCHARGE �L� <br /> REASON FOR SPRINKLERS � <br /> STATEENERGYSUHCHARGE <br /> FPPUCATIONACC.BY PLANSAPPROVFDBY CITYOFEVERETT PUBLIGWORKS � <br /> J�j LOCALSALES �C � - <br /> F' $ iJ ? TAX CODE IS 3105 TOTAL <br /> � �D�c� D ��CC�a�s �lzi� Ua� <br /> ir•�b.,c�ed-�-t �u,e�, �,-, �c2nzit <br />