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APPLICATION FOR CONSTRoCTION <br />PERMIT <br />the Evergreen <br />CITY OF evwell <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLET?D IN INK - PLEASE PRINT <br />OWNER MAIL ADDRE55 CITY ]B• PHONE <br />�S ,gss0!_IA.1 <br />❑ NEW ❑ ADDITION I. ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INCFRIOR REMODEL ONLY 6. <br />CONTRACT PRICE WORK <br />CONTACT`'ERSONANDr O <br />,OF. <br />�C�IBE WORKEFO <br />` DE(O�`LVQpW/�, <br />AAA�y�FwllV�f VI S <br />PRO SEDUSEOF yDINO <br />�NYr� LSoIDIrPni <br />LEGAL DESCRrruoNOF Pnor RTYIN NBELowo m HrotrR _comESl 7 <br />LOT— BLOCK OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING IHIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIE D THEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUM. 10 GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE 07 LOCAL LAW REGULATING CONSTRUCTION OR THE PER <br />FORMANCE F CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />1HISPRO TO PERFORM THEWORK FOR WHICH APPLICATION IS MADE <br />AND I M Y WITH THE ATE CONTRACTORS LAW 1827 RCW AND <br />296.2 AC <br />SIGNAT REOFC)NTMCIOno A III )ni AUFNI DATE <br />- — <br />nPP CI BUSINF.S F AN ESSNAME <br />DbV <br />— <br />PTIOJE�i�p DRESS <br />`--_— <br />2oz <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/H NOLG UNITS — 11 P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— R.T.U. M <br />SHOWER <br />_ <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />DISHWASHER <br />HOOD <br />LAUNDRY TRAY <br />_RANGE <br />WATER HEATER <br />_ <br />WASHER <br />WOODSTOVE <br />_ <br />_CLOTHES _ <br />URINAL <br />_ <br />_ <br />METAL FIREPLACE A CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />_ <br />_ <br />EXHAUST FAN <br />SINK (SERVICE -- BAR, ETC.) <br />TOTAL 5 <br />SUB TOTAL 5_ <br />_ <br />_SUB <br />PERMIT S <br />_ <br />_ <br />PERMIT 8 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SET BACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />_ <br />TYPE OF CONST, <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />SIZE OF BLDG <br />NO. OF STORIES <br />05MT. <br />❑ v <br />DEC LOAD <br />MF-CHANICAL <br />OTHER <br />J� <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />HEIOHTLIMHATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY MANS APPR.BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />1 <br />