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AP�i�L.1�AT1�AI FO1� CONISTi;UC'i�rCi�D PEi�lllll'i' <br />t6a Evergroen <br />CIN OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE CO PLET�D IPI INK—PLEASE PRItJT <br />❑ DEMOLITION ❑ COMBINATION [�� BUILDING CI MECHAPi1CAL <br />OWNER MAILAO�PE55 CITV ZIP PHONE <br />,�/F1.G�.C_F'tGs'iisd 7.n/n /7�-'r`si .�`GsE,FEi� 1sZ <br />TENANT <br />OESIGNER MAIL �D'JRESS <br />iq M1IAILADDRE55 <br />,-,c�.�;��,v �.�, <br />:TOR MFILAO�RESS <br />PLUMBINGCONTR�CTOR IAAILp�ORE55 <br />CLASS OF WORK <br />❑ NEW � J ADDITION �ALTERATION �REPAIR <br />� ENANT IMPROVEMENT OR INTERIOR AEMODEL OIiLV <br />CONiRACT PRIGFOF WOiiN: �%OL�, � V <br />OESCPIBE WORK AN� SOUARE FAOGI�GE INVOLVE� <br />�onFi,r//_ e< L�i!/YiEi � �,rii'w/C.oni.i—" <br />--.-----....__._..._._....,-_....----.._.._..___.---- --� <br />ior / V Z o�ocK 3� oF %,Sl.� �.L.�T <br />� u n , <br />PHOJECTAOORE55 �� ` , <br />�c/o /7 .� i ._, ,�s'E/1. <br />PLUMBING <br />D. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />KITCHEN SINK 8 DISP <br />DISH WASfiER <br />LAUNORVTRAY <br />CLOTFIES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FRONTSETBACK <br />USE ZONE <br />rmE oF coxsr. nuowaeie <br />SIZE OF BL�G. <br />OCCUPANCYLOAD <br />qEF50N FOR SPRINKLERS <br />SUB TOTAL $ <br />PERMIT 3 <br />TOTAL FEE S <br />CITV ZIP <br />CITY ZIP <br />GITY ZIP <br />'�� 9 �l � <br />cirr nv <br />❑ Pi_UMBING <br />PHONE <br />PMONE <br />PNONE LICENSEk <br />�sllrl� ✓�G�'.n, <br />PHONE LICEVSEM <br />PNONE LICENSEn <br />everett <br />� <br />❑• SIG�V <br />I I DEMOLITION (-I WOODSTOVE/FRPIINSERT ❑ BUILDINGRELOCATION I <br />ICONTACT PERSON �Np PMONE NO. II <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMI!JED THIS <br />APPLICATION .4ND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PFiOVISiONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BF COMPLETED WlTH WHETHEFi SPECIFIED IIEREIN OR <br />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 PROPERT" TO PERFORM THE WORK FOR WHICH <br />4PPLICATION IS MADE ANU I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC�D 296.200 WAC. <br />SIGNAiUREOFCOq7f1ACTORORA n�ORIZED��GENT DAiE <br />` i <br />N � <br />} .__ _. �.. Gy=�1� <br />AVPL FNTSCRVBUSINESS��CENSENO.FNDBUSINESSN�ME <br />ME�"HANICAL � <br />10. J TYPE OF EQUIPMENT <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />.^.LOTHES DRYEhS <br />VENTILATION F�N <br />RANGEHOOD <br />WATERIIEATER <br />th'OOD STOVE <br />METAI FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS FIPING <br />EXHAL'ST FAN <br />REARSETBACK SIDESEiBAGK PLANGHECNNUl.IBEH <br />IOTAREA <br />ivPE OF WNSC AC7UAl <br />NO. OF Si0RIE5 <br />FIR[ SPpNKIEHS fiEO'� <br />L 1 YES I J NO <br />APPLICATION AGC. BY PLANS PPPROVED BV <br />VACANT $ITE FEES <br />i I YES Il NO _ BUILDING <br />xcurnr+cr uoarowtwricuvns <br />cnaur <br />PLUMBING <br />On,EMErvi MECHANICAL <br />I � YES I.I NO <br />HEIGHTLIlAIiAT10N OTHER - <br />STATE BUILDING SURCHARGE <br />STATE ENER ,Y SURCHqflGE <br />CITF OF EVERETT PUBUC WORNS <br />LOCALSALES <br />TAX COOE IS 3105 rorn� <br />0 <br />� <br />SUB TOL1L S <br />PERMIT $ <br />TOTAL FEE $ <br />FEE RECEIPTNO. <br />VALUATION FEE <br />va�' �„ <br />i <br />��� <br />L� <br />� <br />T 'S� <br />T <br />I <br />� <br />� <br />i <br />T <br />G � r <br />