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APPLIC�TIOn FOi; �:�DNSTRUCT��N PE�tM11� ���`�tt <br />TO 6E COMPLETED IN INK—PLEASE RRINT � <br />f�o Evorgraen <br />CI7V OF <br />�verett � <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION XXCOM9lNQ,TION <br />OWNEfI MAILADDPE55 <br />Gree Becl-man/Jim Johr.son P.o. b <br />HEATING SYSTEM: ��kGAS ❑ ELECTRIC ❑ <br />EUILDING FdECHANICAL <br />dTY ZIP PH011E <br />ciTv <br />AFCMRECTOROEiIGNER MNLADURE55 CI�Y I�P <br />N/A — -- — <br />GENERALCONTR�G70R MAILAODRE55 ��T� Z�P <br />Alackliawk Cont. P.o. Box 3291 Kirkland, Wa 98083 <br />MELMANICALCONTF �GTOR 61FILPDDRE55 �•�T� Z�P <br />N/A <br />PW!IDINGCO'�TRACTOR M/iLFD�RE55 ��T� ZiP <br />N/n <br />GLASS OF N'GRH <br />X NEW :� . ADDITION .� ALTEFATION �� REPAIR DEMOLITION <br />CONTRACT PRIGE OF WORN <br />OFSGRIDE WORK ANO SOl1ARE� <br />PR POSE� USE OF BUILOING <br />� t Qi(A1 <br />LEG�L �ES IPTION OF PFOPE <br />�p7 �IOCN <br />PROJECT A�[1RESS <br />% P S / Ol'L.�[ c.C, <br />�SHOWN �ELOW OR FTTACN FOUR COPIE51 <br />OF <br />o` IIO / � � / <br />PLUM�ING <br />p, TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />� LAV.QTORY (WASH BASIN) <br />I SHOWEH <br />KITCfiEN SINK & DISP <br />DISHWASHER <br />) LAUNDRY TRAV <br />CLOTHES WASHER <br />) URINAL <br />) DRINKING FOUNTAIN <br />) FLOOR DRAIN <br />) BACKFLOW PREVENTERS <br />) ROOF DRAINS—RAINLEADERS <br />) r51NK (SEFiVICE—BAR, ETC.) <br />�UB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FfiONT SETBAGN FEAR SETAAGK <br />Zo, Lo, <br />USEZONF LCTAFEA <br />�-L 5(� <br />ivPEOFLONi5ALL0Y/AOIE 7VFEO-G�W7-NSLAC <br />� L.� .\I_-IJ <br />.,._I�oZ SF + <br />3f3o Sf�l� <br />OCCUPnNCYLOA� <br />��A <br />REFSON FOR SPRINKLER$ <br />NOAF STORI[S <br />� <br />FIFE SPRNKLERS R[O'D <br />N� <br />iNTAKEBY �'LANSAPPPOVEDBY <br />v�,'�� q� <br />FEE <br />SIpE SETBhCK , <br />S <br />VACANT SITE <br />o«�..,�. � 5 � ow<«,.,� �, <br />L�OL� <br />� <br />BASE6fENT <br />MEIGHT LIIAITUATION <br />2Q� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />- � <br />PLUMBING SIGN <br />9110NE <br />PMONE <br />338-2535 <br />PHONG <br />PNG4E -' <br />WOODSTOVE/FRPLINSFFT <br />ario PNor+i: eo. <br />LICENSE a <br />BLACK}iC7.27B7 <br />LICENS: k <br />LiCENi= � <br />BUILDING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE REAI) AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT. 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 />AU'fHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of- ANY <br />OTHER STATE OR LOCAL LAW AEGULATING CONSTRUCTION OR THE <br />PERFGRMANCE OF COtJSTRUCTION. THAT I AM AUTHORIZED 8'f THE <br />OWNER OF THIS PROPERTV TO P� RFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AiVD 296.200 WAC. <br />SIGNFTUREOFCOtJTRACTOPORAUTMORIZEDAGENT DATE <br />X �IC�// .COL�i� _ <br />APPLICANTS CIT\' BL5117[SS UGEN - NU. aN� BUSINE55 NAME <br />7YPE OF E�UIPM�NT FEE <br />A/C—AIHMGLG UNITS—HP. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHCATeRS—B.T.U. M � <br />CLOTHES DFYERS <br />VENTILATION FAN � <br />RANGEHOOU _ <br />WATER HEATEA <br />WOOD STOVE � <br />METAL FIREPL,�C�: & CHIMNEY ' <br />FIREPLACE INSER � <br />HEAT PUMP ' <br />GAS PIPING <br />EXHAUST FAN _ _ ..,_, <br />SUB TOTAL 5 Lp <br />PERMIT 5 � <br />TOTALFEE S 60 ' <br />3/3.30� <br />CHECKNUMBER ��� y��� �EGEIPTNO <br />BIIIL�ING r��t7�� y�a; <br />PLUMBING � <br />MECHANICAL <br />ADDITIONAL PLAN CHECK '?f �i <br />i <br />OTHEF � <br />— —� <br />STATE BUILDING SURCHARGE y � � <br />— — i <br />PG'uUC WORHS L� �GO <br />TOTAL �-i'7 ; j�S� <br />� <br />