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APPf CATIOI ;OR CONSTI CTILA PERMIT everett <br /> the Evergreen TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OFt} �-- `' J <br /> everett I HEATING SYSTEM: D GAS IELECTRIC ❑ (,L <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> • . DEMOLITION r COMBINATION BUILDING MECHANICAL PLUMBING SIG <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> /r,NhAite b "6'se 3 S'Z 7 l,Jzritro,e, 4.-x 9 7 o c z._ --z.- z.3 z_ <br /> TENANT MAIL ADDRESSA7 .gox /2 CITY ZIP PHONE '`��6 <br /> f/O Qu - UA r <br /> l. m F'STO <br /> ARCHITECT OR DESIGNER MAIL ADDREE 3 CITY ZIP PHONE - <br /> /RPr .DES/a,n/ /z 5"ii 8ai4v&: G.� Gc.e <br /> vE7r 7rZ or 3y7 D 9. y <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE ICENSE* <br /> 0w 14, <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE N <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE* <br /> CLASS OF WORK <br /> ..: NEW X ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEJFRPL INSERT BUILDING RELOCATI <br /> /�` (//J1�/^�J ( r CONTACT PERSON� �^�, AND PHONE NO. /y�j J <br /> CONTRACT PRICE OF WORK /0/, / V O e.- 4 -5f to J Y{I v r ��Ate/'- _347 V i f"/ <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED ' <br /> /PQMdASL - bo,etit se A01)iTIO/ FR4A,,c DLO-5E 533 -63'76. <br /> PROPOSED USE OFBUILDIN I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH <br /> acj 3 -F- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> LEGAL DESCRIPTION PROPERTY(SHOWN BELOW OR ATT CH FOUR COPIES „ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> GC/ V/ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE'N k. <br /> LOT ►3 BLOCK / OF NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI <br /> /�4 AUTHORITY TO VIOLATE OR CANCEL E PROVISIONS OF A; <br /> ���y,� '�vJ�^ �[Jf1Y� ,,n OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br /> I '� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY T <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI <br /> . APPLICATION IS MADE AND I COMPLY WITH THE STA <br /> CONTRACTORS LAW 18.27 ROW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X Arc `� 2 <br /> . PROJECT ADDRESS/ <br /> 3 r2.7 Ii.IEr Ale &"�..2�2� AP ICANTS CITY BUSINESS LICENSE NO.AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> / ', <br /> WATER CLOSET(TOILET) ,J A/C-A/HNDLG UNITS-H.P. <br /> / BATHTUB ./-; FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> / LAVATORY(WASH BASIN) .5 UNIT HEATERS-B.T.U. M <br /> / SHOWER ,T' / CLOTHES DRYERS <br /> / KITCHEN SINK&DISP S: 1 VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY / WATER HEATER <br /> _� CLOTHES WASHER !; WOOD STOVE <br /> / URINAL METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN . HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS jp EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> e <br /> • <br /> SUB TOTA! $ 30 SUB TOTAL $ ;%(j <br /> 43 PERMIT $ , <br /> PERMIT $ — TOTAL FEE $ --� <br /> - TOTAL FEE $ <br /> FOR OFFICE USE O"ILY: <br /> FRONT SETBACK REAR SETE CK SIDE SETBACK PLAN CHECK NU BER FEE , RECEIPT NO. <br /> 2.0' 2_0' $ .' gI z-(PSr z l q0 ' 1/7-foQ-7 <br /> USE ZONI LOT AREA VACANT SITE F ES VALUATION FEE <br /> 1 9 ,D/IV /2Z0 <br /> n BUILDING <br /> TYPE OF CONTS ALLOWABLE TYPE OF CONST.ACTUAL 'LUPANCY I NO O�ME:LING_N3 <br /> �r II -0- /� PLUMBING 1� <br /> ,,,,,,„„w_ NO.OF STORIES BASEMENT 1.:e/ MECHANICAL 60i <br />