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Q�� APPLICATII �� FOR CONSTRUGI �Ohl PERMIT <br />fhe Evergreen <br />CITY OF <br />everett <br />BUILDI'dG DEPARTME�NT <br />259-8810 TO P,c'�^,OMPLETED IN INK—P��L�E/A�E PRINT <br />❑ DEMOLITION ❑ COMBINATIO'rJ LJ BUILDING �/i'mtCHANICAL ❑ PLUMBING <br />O"� R MFILADDRE55 CIiV ZIP PHONE <br />VILI�ALL. �nfYl(1-�-�'' Gill% Qi'�7 `inii.tD.��' ���nn�+f cKl�!'�? ��,c,_u�ini <br />ARCHITECT OR DESIGNEfl <br />MAI� pO2DRESS <br />� � ��1� <br />CITV ZIP PHONE <br />CITV <br />everett <br />� <br />❑ SIGN <br />ZIP PHONE <br />�uNLo 10�-"rL� <br />ZIP PNONE LICENSE� � <br />MECHANICALCONTRACIDR MAl1.pODfiE55 CITY ZI^ PHONE LICEIlSE� <br />PLUM�ING CONTpACTOR MqIL AODPE55 CITV 21P PHONE LICENSE I <br />CU55Of WOFN <br />C] NEW ❑ ADDITION I <br />TENAtlT IMPROVEMEY70R INTEFIOR REMO�EL M:� v <br />CONTMCT PRICE OF WORK: �� � �� <br />DESCRIBE WOHK AND SOUARE FOOTAGE INVUIVED <br />LOT BIOCK <br />)0,.� (040 2 � (S <br />�N ❑ FEPAIR CI DEMOLITION ( 1 WOODSTOVE/FRPL INSERT ❑ BUIIDING RELOCATION <br />BELOW OR ARACII FOUR COPIES) <br />OF <br />PFl0.IECTADDR;`/W, 1 �, 11�J CJ�`-/�'�—� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATOHY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UPINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF! OW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FRONTSETBACK REARSETBACv. SIOESETBnCK <br />USE2INJL I LOTAREA <br />ttPEOFCON5I.ALLOWABLE I TYhiUiCONSi.ACiUAL <br />SIZF OF BLDG. <br />OCCUPAI6Y LOAU <br />REASON �OR SPRINKIERS <br />APPLICA710N ACC. �Y <br />NO.OF STORIES <br />FIRE SPRNKLERS FEO'D <br />❑ YES C] NO <br />PLANS APPROVED BY <br />PERSON <br />' _ . 1. <br />�dZ3 ��k�.`�4 <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 GOVESNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME'i0 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL ?HE PROVISIONS OF ANY <br />OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCI'ION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.£00 WAC. <br />SIGNATUFiEOFCONTRAC70ROHAUTHORIZEDAGENT UATE <br />x � 0 20 3�2 <br />�012�/°13 <br />APPLIC 1T5 GN BUSIN SS LI NSE NO. AND BUSINE55 NAME <br />ucru�uire� <br />TYPE OF EOUIPMENT <br />AI�A/HNDLG UNITS—H.P. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATERIIEATER <br />�AETAL FIREPLACE L CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PLAN <br />VACANT S11E FEES <br />❑ YES f7 NO BWLDING <br />OCCUPANLY HOIXbNFIl�HG11H�15 <br />GxWP <br />PLUMOING <br />BnSEMENT MECHANICAL <br />f_I YES I_l NO <br />NEIGHTlIM1iATION OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />CITY OF EVERETf PUBLIC WOflKS <br />LOCALSALES <br />TAl( CODE IS 3105 TOTAL <br />FEE <br />i <br />----�— <br />M E.A. � <br />� <br />i <br />i <br />� <br />�__ �.. <br />SU9 TOTAL $ rJ' O 'U�/ I <br />PEflMIT $ � g%._ QQ � <br />TOTAL FEE $ ; U <br />FEE RECEIPTNO. <br />VALUATION FEE � <br />i <br />1 <br />i <br />� — <br />i <br />i <br />� <br />i <br />i <br />— — ' <br />