Laserfiche WebLink
� r�, <br /> APPLIC�.t10N FOR CONSTRI..:T10N <br /> PERMIT <br /> the Evergreen i,�i,��,�� <br /> GTY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER AIAILP�OHE55 C'TY ZIP PMONE <br /> E�ifEi7l�yl. f��ar.�P ,¢e,a- ��TaT�,,E�GIa� i3�1 Gc���� AUP� �r',u=i��T `782n( <br /> TENANT MAtLADDRE55 C�TY 21P PNONE <br /> r'��i1/"��S!-1qU�T GUE��o7 9aU /���1� �tli. G!/E,C¢7T �BZvI 25� �ZrS`� <br /> RRCNITEQOROESIGNER MARAODRESS CITY ZiP PMONE <br /> /��/ i Z2l •2n� ,p� �3>0 �E,oi7Z� 98/�7/ 34_3-3044 <br /> GENEPNLCONTFRCTOP MAILApOR[55 CIiY ZIV PMONE LICENSE• <br /> se���, �s�. �a2� ��K ,�� �, pv. .� ���o �,�n�, w�, ������ �� '77� cjE-GG"E� � <br /> MECH�NIC�LCONTRACTOF MnILADDRESS CIIY 21P PMONE IICENSE.•37ZN� <br /> �l�G,�� /��i��Qti //�5�� /?�. Nlfr�/ 5 S�rl� �8/f�8 7�3-i9ao Z23-ol-HJ�-Ga- <br /> PLUAIBMGCONfRACiOR MAILADOPESS CIiY 21P PHONE LICENSE• <br /> pn7 -Zy�'�`I <br /> CLASS OF WOflN <br /> ,F�I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOO�STOVE/FRPL INSLRT ❑ BUIL�ING RELOCATION <br /> TENRNTIMPHOVEMENTJNINTEHIORREMODELONLY � CONTACTPERSONANOPMONENO. <br /> CONTR�CTPRIGEOFWORK � f � Ill G�� <br /> OESCRIBEWOFNANpSOUAREF00iAGEIN WED v 3�3 �o�� <br /> I�E�ir;oL �FIcG Te�u��T i.��id'�r�e��� <br /> PRUPOSED USE OF BUILDING I HEREBY CERTIFV THAT I HAVE READ AND EXNMIN ED THIS APPLICATION AND <br /> ����L pf=FIGE� KNOWTHESAMETOBETRUEANDCORRECTALLPROVISIONSOFLAWSANO <br /> LEG�L DESCRIPTION OF PROPE(itt�SMOWN BELOW ORATfPCM FJUR LOPIE51 ORDINANCES GOVERNING THIS iYFE OF WORK WILL BE COMPLETED WITH <br /> WHETHEtiSPECIFIEDHEREINOR NOT.THEGRANTINGOFAPEFMITDOESNOT <br /> PRESUM1IE TO GIVE AUTHORIN t0 VIOIATE OR CANCEL THE PROVISIONS OF <br /> �oT tl�oc� oF ANYOTHERS7ATEORLOCALLAWPEGULA7INGCONSTRUCTIONOR7HEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM�UTHORIZED BV THE OWNER OF <br /> THIS PROPERTV TO PflRfORM THE WORK FOR WHICH APPLICATION IS MADE <br /> _ AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296.200 WAC. <br /> SIGNAiUF[OFCONiRACiORO�:.U➢IORIZ[DAGE DATE <br /> , _ x�-� �,.����1 <br /> PROJECT�ODRC55 , � <br /> ��'�r O /3� �c�e�e �/� APPLICA iSCITYBU51NE5511C[NSENO.ANOBUSINESSNRME <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WA1 ER CLOSET(TOILEn A/C—A/HNDLG U NITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M EA <br /> LAVATORY(WASHBASIN) UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS _ <br /> KITCHEN SINK 8 D:SP. VENTILATION FAN <br /> DISN WASHER RANGE HOOD _ <br /> LAUNORV TRAY K'ATER HEATER _ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEAOERS EXHAUST FAN <br /> SI NK(SERVICE—BAR,ETC.) <br /> SUBTOTAL 5 SUBTOTAL 5 <br /> PERMIT S PERMIT S <br /> TOTAI FEE 5 TOTAL FEE 5 <br /> FRONTSET�AGN REAfi5E19PCK SIOESETBRLN PIANCH KNUMBEH p FEE�,�� a NEiE�NO.�D <br /> cL!I��O `� � � <br /> � =� � LOTAREF vnCarvrsire FEES VALUATION FEE <br /> ❑YES NO � <br /> BUILDING ��� �__��_C� <br /> TYPEOFCONSi. OCCUPANCYCROUP NO.OF�WELLINGUNITS <br /> ALLONPBIE/RGiUALT�� � � � �$ PLUMBING <br /> // i <br /> SrzeoFe�oc. r+o.oFsroaies sM occ�wo MECHANICAL � <br /> ,3,� o s� i �3 <br /> HEicnrun+irntioH OTHER <br /> LIFE SPRINNLERSREOUIRED O YES ' 0 � STHTE Bl11LDING SURCHARGE � <br /> STATE ENERGY SURCHARGE <br /> qP\ATIOt ACG BY VLANS��V PUBLIC WORKS _ <br /> TOTAL � <br />