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� � <br />APPLICAT��ON FOR CONSTRUC r10N PERMIT <br />the Evergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />S7 DEMOLITION i_] COMBINATION X BUILDING i: MECHt,NICAL <br />OWNER f �/� ��y LAODRE55 CITV ZIP PMONE <br />�CiwRrd IVl.��10�rcwJ z��cdbu ��� ��ZD� 2 <br />PLUMBING <br />iENANT MFIL ADDRE55 CITV ZIP PHONE <br />ARCHITECTOFDESIGNER M�ILADORE55 CIN 21P PIION6 <br />GENEHALCONTRRCTOR MAILRDDRESS QTV 21P PHONE LICENSE• <br />MECXANICRLCONTFACTOR MAILAOORESS qTV 21P PMONE LICENSEt <br />PWMBINGCONTRACTOR MAIL <br />ZIP PMONE IIGENSEt <br />everett <br />e <br />"� SIGN <br />I' NEW ❑ ADDITION X ALTERATION i.' REPAIR ..� DEMOLITION i�. WOODSTOVBFRPL INSERT �I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODELONLY I CONTACT PERSON AND PNONE ND. <br />CONTMCT PRICE OF WORN: <br />DESCRIBE WOFN AND SOUARE FOOiAGE INVOLVED � 1 q� <br />r ` � /�� <br />�Er�4J i.� �'r �i L� � W 0 I I S 1 h2 SfS �"T' <br />PROPOSEO USE OF <br />LEGAL DESCRIPTION OF PROPEFTY �SHOWN BELOW <br />LOT�_ BIOCK L�s UF <br />�@CC�V('IPfI 14 Vdl��'1�1r <br />C. o u h� �, .� <br />Zaz3�s� <br />PROJECTADDRE55 <br />PLUMBING <br />NO. TYPE Of <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS ' <br />SINK BERVICE—BAR, ETC.1 <br />FRONTSETBACK <br />USE20NE <br />lYPE OF CONSi. AILOWFBIE <br />SRE OF BLDG. <br />OCCUPANCVLOAD <br />REASONFORSPRINKLERS <br />APPLICATION ACC. IY <br />� j� � A1 U V1 U�'Y'1 1� <br />I HEREBY CEiiTIFY THAT I HAVE READ AND EKAMINED THIS <br />APFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THF pROVISIONS Or ANV <br />OTHER STATE OR LOCAL LAW ReGULATING CONSTRUCTION OI' THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED �Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FiJfi WHiCi-I <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW �ND 296200 WAC. <br />SIGNATUFEOFCONTRRCTORORAUTNDAIZEDAGEHT DATE <br />XC�� �� <br />APPLICANTSGITYBUSINESSLICENSENO.A �BUSINESSNAME <br />MECHANICAL <br />VO. TYPE OP EOUIPMENT FEE <br />!VC—A/HNDLG UNITS—H.P. � <br />FORCED AIR SVSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M ' � 0 U <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE ' <br />METAL FIREPLACE & CHIMNEY � <br />FIREPLACE INSERT ' <br />HEAT PUPdP � <br />GAS PIPING ' <br />EXHAUSTFAN � <br />PERMIT $ <br />TOTAL FEE $ <br />FEAR SETBACK SIDE SETBACN PLAN CHECK NUMBER <br />LOT AREA VACANT SIiE FEES <br />� -��. YES �� BUILDING <br />iYPFOFCONSi.ALiIIAL acucr.Na NaaoWUUx6uNrts <br />cuo 0 <br />,� 7_ � PLUMBING <br />NO-0FSTORIES BA EMENT MECHANICAL <br />� : : YES �. . NO <br />FIRESPRNKLERSFEO'0 MEIGHTLIMITATION OTHER <br />�.-��, YES ,' NO STATE BUILDING SUI7CHARGE <br />STATE ENERGYSURCHARGE <br />PLANS APP VED BY CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />�,� TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE RECEIPTNO. <br />y000 63 l o0 <br />i <br />� <br />�— <br />�5 <br />