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APPLICATIt�N FOR CONSTRUCT�ON PE�MIT <br />the Evergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />C DEMOLITION - CO�ABINATION p� BJILDING MECHANICAL <br />_.._.__ .uu nnnoccc CITV ZIP PNONE <br />PLUMBING <br />G�t�1T:-iV4 �h�i-�171�1-� 562 MoE �..� ts�. �o r-� io i <br />TENANT MAILFDDRESS CITY 21P PMONE <br />ARCHITECTOR�ESIGNER MAILAD�RESS QTV ZIP PHONE <br />• / i7� J / <br />GENERAL <br />�w NL�L� '�/Iti <br />CONTPACTOF MAILADDflE55 <br />PLUMBINGLONTRACTOR MAILAODFE55 <br />CLASS OF WORK <br />�S.G NEW ❑ ADDITION u ALTERATION <br />TENANT IMPHOVEMENT OR INTERIOR REMODEL ONLV <br />CONTRRCT PRICE OF WORN: <br />oFSf.RIBE WORK ANO SOUARE FOOTAGE INVOLVED <br />CITY <br />ZIP PMONE UCENSE • <br />� <br />CITY 21P PMONE LIGENSE• <br />everett <br />e <br />' SIGN <br />._'�: REPAIR :. DEMOLITION ���. : WOODSTOVEIFRPL INSERT :J BUILOWG RELOCATION <br />�p IC�M ANOP N��� a���'T��/ <br />�jV�L.D �� �9 �s�C47/ 1«A�✓' <br />PflOPOSED USE OF BUILDING <br />���'� �%i�Gc% <br />LEGAI DESCRIPTION OF PflOPEFTY (SHOWN BELOW OR ATTACM FOUR COPIES) <br />�p7 BLOCK OF <br />U IJ'�TTt� o W�3�r� i(+� T?8. <br />�_5�" Ia2P�' 2-oo3—�c:� 5►`�' <br />�-�1�' 1 l �ti"��KirJ <br />PAaec{r�o� naess _ � ,.r{�y.� �. Je- �s J�- r`''r� I 1 <br />V� � • �� <br />PLUMBING <br />un. 7YPE OF FIXTURE OR ITEM PEE <br />SHOWER <br />KITCHEN SINK & <br />DISHWASHER <br />LAUNDRI'TRAY <br />FLOOR <br />SINK <br />FRONTSETBAC' <br />2� <br />USE ZO <br />TYPEOFCONSi�LLOWABLE <br />V��.i <br />SIZE OF BIDG. <br />��� <br />OCCUPANCYLOpO <br />REASO FORSPRINkLERS <br />APPLICATION ACC. BY <br />0 <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 WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF COiVSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS 7 RC 296.200 WAC. <br />SIGNAiUREOF .1AACT0 TNOHI AGENT �ATE <br />X <br />APPLICANTS CI7V BUSINESS LICENSE NO. AND BUSINESS NAME <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ ' <br />REARSETBACK SI�ESETBACK � PLANCHECHNUMBF.R <br />zU� s �� a 3� <br />LOTAReA � 1 VFCANTSITE FEES <br />��0 r �_: 1'8S .. NO gUILDING <br />iVPEO�tONST.AC7UAL o[cuvnn[r xoor�w[Luacuxir5 <br />ceour ��. pLUMBING <br />NO. UF SiOFIES BASEMENT MECHANICAI <br />I YES NO <br />FIPESPRNKLERSREOD NEIGHTUMITqTION OTHER <br />_�, YES K NO �i STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHAfiGE <br />PLANSaPPPOVEDBv ��n' OF EVEHE7T PUBLIC WORNS <br />� LOCAL SALES <br />TAX COUE IS 3105 TOTAL <br />M E.A. <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FEE RECEIPTNG. <br />GY3 � 33': <br />n <br />� <br />i <br />� <br />