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the Evergreen <br />CITY OF <br />everett <br />BUILDING ^EPARTMENT <br />259-8810 <br />APPUCA iION FOR CONSTRto%:TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MA-L ADDRESS CITY ZIP HONE <br />7�X 2Cc� %ni«l�/ <br />TENANT ALL ADDRESS CITY ZIP PNONE <br />ARCH ITECTOR DESIGNER MAIL ADDRESS CITY ZIP PHCNE <br />GENERAI.CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LIGENbt <br />555 z4cz: <br />s S Sl�n< <br />co, l°/9c s:o ve-'c .r <br />izico <br />MECHANICAL <br />MAILADURESS <br />' Ii 9 <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />.IVl d , ,;6; r=:jkoLys . a s / - <br />21P <br />PHONE <br />LCENSE • <br />PLUMBINGCON'rRACTOfl <br />IL ADDRESS <br />CITY <br />OFWORK <br />�C <br />_.. r-I <br />r I rl rl ncA.lro rclnM <br />(1 WnnnRTnVFIFRPI_ <br />INSERT <br />❑ BUILDING RELOCATION <br />TENANTIMPROVEMENTOR INTERIOR HEEMODE'LtONLY <br />CONTRACT PRICE OF WORK 017,00v ��(�(�({ �Ll ,l'L <br />CONTACT PERSON AND PHONE NO <br />V< <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED'JSE OF BUILDING W� ^--�— <br />SG�,'/�G ��I�O� <br />I H E R EBY C ERTI FY THAT I H AVE R EAD AN D EXAM I N ED TRH 19`APPLICATI ON AND <br />KNOW THE SAME TO BE TRUEAND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AU', HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 fCW AND <br />0 WAC. /,,C6 // J <br />OF CONTRACTOR OR AUTHORIZED AGENT DATE (� ✓�l!/ <br />q <br />LE LDESCRIP �ONOF P—ROPERTY IIBN/OfWVN O'ELOW ORATTACH FOUR COPIE51 <br />TOT_ BLOCK OF —_ <br />/1 !� <br />fd" '7i <br />JL �� <br />��� AQ/A�� {�- — <br />PROJECT AD RESS <br />CITY BU IN SB LICENSE O. ANp BUSINESS N>ME <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR STEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C— A/HNDLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHFN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKI413 FOUNTAIN <br />`IREPLACEINSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFL OW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK(SERVICE — BAR, ETC.) <br />— <br />-- <br />SUBTOTAL $ <br />_ SUBTOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />�— <br />Us[ZONE <br />p _ S <br />TYPE <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />❑ YES ❑ NO <br />PUN CHECK NUMBER <br />FEES <br />FEE <br />VALUATION <br />RECEIPT NO. <br />FEE <br />BUILDING <br />TYPE OF CANST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OFBLDG <br />NO.OFSTORIES <br />BSMT. <br />❑Y <br />❑ N <br />occ Lono <br />—LIMITATION <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED O YES O NO <br />HEIGHT <br />STATE BUILDING SURCHARGE <br />(/ <br />APPLICATIONACCBY PLANSAPPR BY <br />Z Z <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />S <br />