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J� o�� <br />APPLICA41d�1 FOR CONSTRUCTrON PERMIT everett <br />TO BE COMPLETED IN INK—PL�ASE PRINT � <br />!�e Evargreen <br />CIN OF <br />eve re�tt HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING )� SIGN <br />OWNER MAILAODRE55 CITY ZIP PHONE <br />TENANT <br />ARCHITECT Ofl DESIGNER <br />GENERALCONTqACTOF <br />MAIL AOORESS 7B.t5 <br />MAIL ADOflE55 <br />AIAIL <br />CITY <br />qTV <br />So. <br />) ITL ' 8 . ......_ <br />�3 � <br />21P PHONE <br />ZIP PHONE <br />it.4g b6 (022 <br />ZIP PHONE <br />LICENSE M <br />1 <br />� Vi � <br />PLUM8INGCONTRACTOR AIAILAUORESS CITV ZIP PHONE LICENSEtl <br />CLASS OF WORN <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL INSERT ❑ BUILDING RELOCATION <br />I CONTACT PERSON AND PHONE NO. <br />� <br />DESCRIBE <br />LEGAL DESLRIPTION OF PflOPEflN (SHOWN BELOW OFi <br />LOT BLOCK OF <br />iQIECTH�DRE55 <br />7�as` �✓�,�,� „ cc�� <br />PLUMBING � <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILE'n <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />DISHWASHER <br />LAUNDAYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINr FOUNTAIN <br />FLOOR DRAIN <br />ROOF ORAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBALH REAR: <br />� <br />TYPE OF CONTS. P <br />OCCl1PANGY LOAD <br />INTANE BY <br />TOTAL FEE <br />Z01 AR� � <br />TVPE Of CONSL ACTUAI <br />NO. OF STORIES <br />FIflE SPflNKLERS REO'0 <br />PLANS APPROVED 9Y <br />r� <br />I HEFiEBY CERTIFV THAT I HAVE flEAD AND EXAMIN[D THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />coriesl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SFI:CIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PfiOVISIONS OF ANY <br />OTHEFi STATE OP. LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 FCW AND 296200 WAC. <br />SIGNANflEOF�ONTFACTOROR fHOflIZE AGENT DATE � � <br />T�INw� �2. iL Q� <br />X <br />$ <br />VACANTSITE <br />U <br />OLLUPA4CY AOAIOWFLUM1GU11115 <br />GP00� l <br />BASEIAENT <br />TAX COOE IS 3105 <br />APPLICANTS CITV BUSINE55 LICENSE NO. AN� Bl1SINESS NAME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CH°CK NUMBER <br />3s'� 8 .� <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PLAN CHECK <br />OTHER ��G�_ <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TO7AL <br />FEE <br />TOTALFEE 5 <br />FEE <br />i <br />i <br />i <br />i <br />�T <br />.� ��O <br />i <br />i <br />i <br />i <br />T <br />I <br />/9 �sv <br />