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� r <br /> APPLICATI�n! FOR CONSTRUCT�a7N PERMI i <br /> !he Evergrcen everett 1 <br /> CITV OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLE�A PRINT <br /> � DEMOLITION _1 COMBINATION -: BUILDING CVMECHANICAL PLUMBING SIGN <br /> OWN MAILADDRESS CITY ZIP PHONE <br /> ,� v�d �/l f�-ow 51T1�,�8��k.��,�i�-9Azo3 3y�o Bz 5�" <br /> TENANT MRIL q�pflE55 LITV ZIP PMONE I <br /> ARCHITECTORDESIGNEP MpIIADCRESS CIN ZIP PHONE <br /> GENERRICONTRACTOR MAILADDRE55 CITY ZIP PHOYE LICENSEY ' <br /> MECHANtCALCONTRACTOP MAIL�I�ORE55 CITY ZIP PNONE LIClNSEr <br /> S�i�n�.t �/F et D�3.%3c'� <br /> PLUMBING CONTRACTOR MRIL ADDRESS CITY 21P PHONE LICENSE� <br /> CLASS OF WORK <br /> �'INEW _7 ADDITION r ALTERATION Ci REPAIR ! i DE��OLITION . -! WOODSTOVE/FRPL INSERT ❑ BUILDIN^u RELOCATION <br /> TENANT IMPPOVEMENT OR INTEPIOR REMODEL ONLY GONTFCT PERSON AND PMONE NO. <br /> CONTRACTPflICE'OFWORK: V � <br /> DESCflIBE WORK AND SOURRE FOOTAGE INVOLVE� <br /> PROPOSEOUSEOFBUILUING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOFPROPEFTY�SHOWNBELOWORATTACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING 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 1827 RCW AND 296.200 WAC. <br /> SIGNATUREOFCONTRAGTOFOflAUTHORIZEDAGENT DATE <br /> i A <br /> PRQ�ECT ADDRESS <br /> APPLICANTS CIiY SIN NSE NO.AN�BUSINE55 NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AIHNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVAT09Y(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> _ KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> UNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WO00 STOVE ; <br /> URINAL � METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; (iAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � ; t <br /> � J_ Ir�� <br /> ' !{ <br /> � <br /> � � <br /> SUB TOTAI. $ ; SUB TOTAL $ / " � <br /> PERMIT $ � PERMIT $ � ` <br /> TOTAL FEE 5 ' TOTAL FEE $ p J_ '_ <br /> FRONTSETBACK REARSETBACK SIDESETBACK PIANCMECNNUMBER FEE RECEIPTNO. <br /> USEZONE LOTAREA VACANTSIiE FEES VALUATION F�E <br /> ❑ YES J NO BUiLDiNG ' <br /> ttPEOFCOHSTALlOWABIE iVPEOFCONS?ACiUAL OCCUVAHtr NoovmvEWNGuxrtS <br /> GPWV <br /> PLUMBING ' <br /> SIZE OF BLUG. NO.OF STORIES BASEMENi � � <br /> MECHANICAL 3a � <br /> ❑ YES Ci NO <br /> OGQIPANCYLOAO FIRESPRNI:IERSREO'D HEIGHTLIMITATION <br /> OTHER ; <br /> fJ YES ❑ NO STATE BUILDING SURCHARGE i <br /> RERSOIJ FOR SPRINNLERS <br /> STATE ENEiiGV SURCHAFiGE � <br /> i— <br /> APPLICATION RCC.BY PLANS APPROVED BY CITY OF EVEflE1T PUBLIC WOflKS � <br /> LOCALSALES ' <br /> TAX CODE IS 3105 T�TAL �" � � <br /> 30 � <br />