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APPLICATION FOR CONSTRUCTIa.'N PERMIT II <br /> the Evergreen TO BE COMPLETED IN INK.-PLEASE PRINT <br /> CITY OF <br /> everett FFATING SYSTEM: �S O ELECTRIr ❑__ <br /> BUILDING DEPARTMENT <br /> 259.8810 <br />•. 1 DEMOLITION 74 COMBINATION (/BUILDING MECHANICAL PLUMBING SIGN <br /> OWN R MAIL ADDRESS CITY ZIP PHONE <br /> it 6rcbC _Tim F_YozO slain 0gal)P lc�9 o5wz (sad) ,13l-ve lly <br /> TENANT MAIL ADDRESS TY ZIP PHONE <br /> ARCHITECT OR DESIGNERMAIL ADO,ESS CITY ZIP PHONE <br /> D1ZZ' )4rC6. Alwh Irx CirrG1/» A/4 ` ' pz�- l7ZEi <br /> GE.EAAL CONTRACTOR MAIL ADDqES& CITY ZIP PHONE INCENSE/ <br /> 7- u K 27)doc �5+�/K : ezodl) _ 7N_'U07 <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP ��— PHONE LICENSE/ <br /> PLUMBWGCONTRACTOR MAIL ADDRESS CITY ZU PHONE LICENSE/ <br /> )rS F WORK <br /> NEW ❑ ADDITION C ALTERATION _ i REPAIR 1.7 DEMOLITION 1 I WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br /> IONTACT PERSON AND PHONE NO./ <br /> CONTRACT PRICE OF WORK _ )iT)YI Q� <Ir�;P_IJ A,rn <br /> DESCRIBE WORK AND SOIARE FOOTAGE I OLVED b"a , <br /> o�ishE, <br /> PROPOSED USE OF BUILDING / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> —M ItLOF l7/ I`FS/ / ADPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DE IPTIONO PROPERTY HOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOr BLOCK of /1/ � 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 ANY <br /> _ OTHER STATE OF,LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATI^N IS MADE AND I COMPLY WITH THE STATE <br /> CONTR ACTORS LAW 18.27 RCW AND P..98.200 WAC. <br /> SIGNATUI E O CONTRACTOR OR AUTHORIZED AGENT DATE <br /> n N <br /> /'G9ce- Ss x <br /> PROJECT ADDRESS �••C��T!'u_ 1 <br /> APPIKAN S f ITY BUSINESS LICENSe NO ANDB161NESSNAMC <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEF. <br /> WATER CLOSET(TOILET) .S' A/C-4HNDLG UNITS—H.P. —',— <br /> BATHTUB $ ; FORCED AIR SYSTEMS—B.1.11 M_E.A. <br /> LAVATORY(WASH BASIN) I UNIT HE,TERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 6 FISP R VENTILATION FAN <br /> DISHWASHER I RANGE HOOD T— <br /> LAUNDHY TRAY ; WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY j — <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) to leld AMMIO� <br /> I <br /> I <br /> I <br /> I <br /> I ' <br /> SUB TOTAL $ — SUB TOTAL <br /> PERMIT $ PERMIT $ I <br /> TOTAL FEE $ 1 TOTAL FEE S 0 <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACKPIAN�H�,O MB R FEE '30 -I RECEIPT NO <br /> USE ZONE LOT AREA VACANT SfTE G /FE VALUATION3 FEE �— <br /> BUILDING <br /> TM(EOLONTS ALLON'ABl[ TYPE Of CONST ACTUAL OCO/AACv Aowmu*K;w" <br /> rY/ �- L//pX AAIMr PLUMBING <br /> SIZEOFSIDG NOOFSTORIES BASEMENT MECHANICAL ' <br /> > a <br /> OCCUPANCYLOAD FIRE SFRNKLERS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> REASON FOR SPRINKLERS OTHER <br /> STATE BUILDING SURCHARGE i'60 <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES VU <br /> TAX CODE IS 3105 TOTAL ' ' <br /> /1f <br />