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APPLICATIOtw'�FOR CO�ISTRUCTI�Pi PERMIT �'�'�«'�` <br /> � � <br /> tno Evergreen <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> CI7V OF <br /> everett HEATING SYSTEM• ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> �9 ✓Q�YN�E IdAiLAD�RF.55 Clrv LP �1 PMONE <br /> //C!�-.�C-Ct -t....� � G o r ��')9 c � Ps.-a.1 -.� �/i�6 �.-Y�t•"-''•<-�_ G'R ��`r� �/7E - �' 7'f 3 <br /> �� � TEN/AN�T MAII R�ORES� CITY ZiP PHONC <br /> `, ti.PC �<,�/CQ I �.-.-� <br /> qRLNITECT OR OESIGNEF MAIL RODRE55 CIiV IiP PMONE <br /> GENENRLGONTRAGTOR MRIIADDFE55 CITY ZIP PNONE ULENSE� <br /> ��� pry 21P PNONE LICENSE/ <br /> �.t�� MEGNRNICRIGONTRAGTOR MhIL�DDRE55 <br /> A.�x Cliv Zi�' PHOHE LICENSE� <br /> 'L."' H PWMBINGGONTR�GTOR MARAODFE55 q <br /> 9HfA �aE�S �iiy�G�`n /c'so9 �i�.it�n�fjuC � ia�v /%,373 ��O �577 �ES �/� <br /> �"� ��' C1A550FWORN t Yn� { � <br /> K n '�.�. NEW : �. ADDITION .✓ALTERATION � �. REPAIfl . DEMOLITION . . WOODSTOVBFRPLINSERT �. BUILDINGRELOCATION <br /> F3'RiI CONTRCT PERSON AND PtlONE NO <br /> � ~� CONTfUCT PRICE OF WONK <br /> (q H <br /> F] ['� DESCRIBEWORKANDSOWAEFOOTqGEINVOLV[D <br /> z � <br /> >�..✓- > > ' <br /> � �3C7 rao s[ous�oFounoir+c I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> � �� ����� _�.P R �` APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEWL�USRIPTIONOFPROPE Y `NOWNBElOW08ATTRCNiWRCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> C,]� C] WORK WILL BE COh1PLETED WITH 'NHETHER SPECIFIED HEREIN OR <br /> � ioi BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> L9-� H y OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> �.y OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> C] Cy V] APPLICATION IS MADE AND t COMPLV WITH iHE STATE <br /> � �� CONTFACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNALUFEOFCONiRACTORORAU1HORiZEORGENT OATE �GI��I%� <br /> zyw <br /> H O p� n �/�,, / � � - / <br /> anaecriw�r+ess X/! n GN// A �✓L/ <br /> ✓ IC�NTSqttB�15ME IICENSENO.ANOBU51NE55NRME <br /> �'� 0 9 6ZEKG �E-E.�/ ��} / <br /> PLUMBING MECHANICAL <br /> � ry0. TYPEOFFIXTUREORITEM FEE NO. TYPEOFEDUIPMENT FEE <br /> ` WATER CLOSET(TOILET) / NC-A/HNDLG UNITS-H.P. <br /> i '�.. � 3 FORCED AIR SYSTEMS-B.LU. M E.A. <br /> BATHTUB <br /> I ""�' LAVATORY(WASH BASIN) �S' � - UNIT HEATERS-B.T.U. M <br /> ' SHOWER � CLOTHES DRVERS <br /> � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> I �I DISHWASHER U ' � RANGE HOOD <br /> Z LAUNDRV TRAY - WA7ER HEATER <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> ��i o� - FIREPLACEINSERT � <br /> DRINKING FOLJNTAIN <br /> FLOOFi DRAIN HEAT PUMP ' <br /> ' GAS PIPING � <br /> ' � BACKFLOW PREVENTERS ; <br /> o' I ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) � �' <br /> / a c_ � _ 1 <br /> _ � I <br /> !ti/A Ih S � i <br /> u.a'� � <br /> i <br /> SUB TOTAL 5 yo �— SUB TOTAL S <br /> I�' � PERMIT 5 0 �� PERMIT 5 <br /> TOTAL FEE 5 eU � TOTAL FEE S <br /> FOR OFFICE USE ONLY: j <br /> �L.—�� iRONT5E7B�CN PEMSETBACK SiDESETBACK PIANLNECKNUMBEN FEE flECEIPTNO. I <br /> USEZONE iotu�ee v�uwiSiTE FEES VALUATION FEE i <br /> BUILDING <br /> IYPEOiCONfSAllOV/ABtE n'PfOiGON51AL1UAl otturun MouvMLLrv.�nns <br /> PLUMBING /O G � '� <br /> i �i <br /> SIZEOFBLDO. NO.OFSTORIES BASE4ENT 61ECHANICAL � I <br /> OCCUPANCYLOAD FlRESFRH1cLER5RE09 HEIGNTLIYITATqH ADDITIONALPIANCNECK � <br /> i <br /> O7HER <br /> nE�50tIFORSPRiNNLERS � <br /> STAiE PUILDING SURCNARGE . <br /> UIT�KEBY f'WISAPPROYCDOY CITYOFEVEHETT PUBUCWORK$ ' <br /> LOCAL SALES <br /> TAX CODE IS 3105 To�^� /v o ; <br /> � <br />