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APPLICATIt,..d FOR �ONSTRUCI.ON PERMIT everett <br />the Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259 8810 <br />HEATI�G SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />l DEMOUTION � COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAILAODRE55 CITY 21P PRONE <br />���/ �RIM1fR i! �/S/RNP ✓IP/-� O�P. L�R/`? h/� 9fr� 9� 3 Sr�" i 7�? <br />TENANT MAILA�ORESS CIIY Z�P PHONE <br />APCHRECT OF DES:GNER MAIi ADORESS GITV Z�P PNONE <br />�ENERAL CONTRPGTOB MAIL A�DflE55 CITV ZIP PHONE LIGE95E t <br />S�g _. l 5 3v�� <br />MECHANIGALCONTRAf,TOF MAILADDRESS CIiV ZIP PHONE UGENSG� <br />PLUMBINGCONTPAr,tOR IA�iLhDDRE55 <br />CLA55OF WORK <br />'.! NEW i�. ADDITION �F ALTERATION <br />CONTPRCTPRICEOFWORK _� <br />oFSCRIBE WORK AND SOUARE.FOOTAGE �NVOLVE� <br />PROPOSED USE <br />X .S /n <br />LEGAL DESCflIP <br />� �or <br />� REPAIR <br />tiif �.vrtrr-i <br />OF PROPERN �SHOWN BELOW O ATTACH FOUR COPIES� <br />- e�ocn oF <br />;,:,� ni,�. /r si�� •L� <br />i�-2Sm�-�-Do3-doo, <br />S/1G0 G'd r!N �� X/f G O�C/� S� <br />��oa ��_ ���r s-i;. <br />� PR0.IECTA�DRE55 <br />PLUMBING <br />un 7vPE OF FI%TIiRE OR ITEM <br />SHOWER <br />KITCHEN SINK 8 � <br />DISHWASHER <br />LAUNDRYTRAY <br />DRINKING <br />FLOOR DF <br />BACKFLOI <br />ROOF DRI <br />SINK (RER <br />SUB TOTAL $ <br />PEP.MIT 3 <br />TOTAL FEE 5 <br />FQR OFFICE USE ONLY: <br />FRONTSETBAGN REARSETBACK <br />I)SE ZONE LOT AREF <br />71f:o�CONiSaIIOWABIE iVPEOFCONSiACiUAI <br />SIZE Of BLW. NO. OF STOFIES <br />OCGUPANCYLONo <br />REASON FOR SPRINKLEPS <br />REO'� <br />iNiAY.EBV I PLANSAFPROVE�BY <br />SIOE SETBFCK <br />ZIP <br />DEMOLITION .� WOODSTOVE/FRPL INSERT .. BUILDIN�9 RELOCATION <br />I CO�wC�P�50%ANDPNONENO. �� / � �� � <br />9 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLETED W!TH WiiETHER SPECIFIED H[REIN OR <br />NOT. THE GRANTING OF A PLRMIT DOES NOT PRESUMF TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL T4E PFOVISIGNS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERfORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS tdADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 18.27 RC D 296.200 WAC. <br />SIGNFTURE OF CONTRAC70R Ofl AU GHIZ AGENT OAiE <br />X� �ti-:-� ,�.. <br />APPUCPNTS CITV BOSINE55 LICENSE NO. AND BUSINESS NAC�E <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VEN'fILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN __ <br />S <br />S <br />TOTAL FEE <br />FEE <br />T <br />PLANGHECNNUM�ER FEE I flECEIPTNO. <br />BUILDING <br />SCOOAMLv NOIX�kIIiWONGS <br />cuouv PLUb�PING <br />BASEMENT MECHANICAL <br />HEIGMT LIMIIATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />�n <br />Yp <br />M <br />� <br />� <br />