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APPLICE.(ION FOR CONSTRl4..:T!ON <br /> PERMIT _ <br /> IRA Evergreen C \ <br /> CITY OF IT <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> OWNLR MAIL ADDRESS arr it PHONE <br /> TENANT MAIL ADDRESSCITY ZIP PHONE '/ <br /> dilisn .41 24 /4/ur3 /, O i/k/A /Fi4 eG7T 98%49/ R -^d 6 T <br /> ARCHITECT OR DESIGNER MAIL ADDRESS <br /> TY 20, PHONE <br /> ,s y/N rivlox. �4,r...e_ <br /> GENERAL CONTRACTOR MAIL ADDRESS ,�-qrY PHONE LICENSE A <br /> _ !b?J.2 $af tt-G •U%F T'%RpM � c <br /> n CieeK 99S06( 7�/3-AEG/ /`Eou(ti121 yx'Z <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY r '3! CITY ZIP PHONE LICENSE• <br /> 1-3 L]H� PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE•-- <br /> [[Sj <br /> p PI x CLASS OF WORK rs <br /> y H 0 NEW 0 ADDITION •[-y,y <br /> ALTERATION El REPAIR 0 DEMOLITION 0 WOOOSTOVE/FRPL INSERT 0 BUILDING RELOCATION <br /> E.I TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> H $ <br /> ea r/ <br /> H H CONTRACT PRICE OF WORK 1,9,0 0G)O_ f /f�� /T�%W /�S�l �G <br /> K' n DESCRIBE WORK AND SQUARE FOOTAGE&OLVED •N7'b K.� j:.' Ie( III <br /> 0 x 0 As Rv,c rm.) !z • <br /> 7l�R ` Jd; 7y�' / <br /> h0 H x kDIwTP I is c- _e_._,ftQxarLJ� '� <br /> CS H PROPOSED USE OF BUILDING i I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> pyx R ••A 1L, s/1 e KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> !I�j9 LEGA DESCRIPTION OF BELOWL OR ATTACH FOUR COMM ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> F] WHETHER SPECIFIED HEREIN OR NOT.THE GRANTINGOF A PERMIT DOES NOT <br /> o <br /> OH PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �y lOif�1'�4 BLOCK 7`3C7 OF I7-�Q ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> Htrl co, FORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE OWNER OF <br /> O. C] THIS PROPERTY TO PERFORM THE WORK F R WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CO ACTORS LAW18.27 AMAND <br /> Z H 296.200 WAC. <br /> M _ SIGNATURE Of TRACTOR OF AUTHORIZE GENT OATS -d/'d y <br /> 80H 4�. .YLI -- <br /> g <br /> C�C CO PROJECT ADDRESS PC A.ilS CrtY BUSMES.Uf.EN..E NO ANO BUSMLSSNMIE <br /> � 3142 '�(X go,rpII.� <br /> H1-3 <br /> 0 CO PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPME NT FEE <br /> WATER CLOSET(TOILET) _— AIC-AIHNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-BT.U. M EA <br /> LAVATORY(WASH BASIN) UNIT HEATERS-BT.0 M ,_- <br /> 1 SHOWER CLOTHES DRYERS _ <br /> I KITCHEN SINKS DISP. VENTILATION FAN <br /> C:_ <br /> t I DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY <br /> WATER HEATER <br /> CI JTHES WASHER WOOD STOVE — <br /> _ JRINAL METAL FIREPLACE&CHIMNEY <br /> L= DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> I a ' I SINK(SERVICE-BAR ETC I <br /> II <br /> ill <br /> SUBS SUBTOTAL S -_ <br /> PERMIT S _PERMIT _S <br /> 'NJ I TOTAL FEE S TOTAL FEE S <br /> FRONT SETBACK PEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> St.' FEES nS /3q 55 t).1t 7 <br /> USE 3 LOT YAw+Ts FEES VALUATION FEE <br /> // ❑YES o <br /> BUILDING EMT 907 CO <br /> TYPE OF CONST. OCCUPANCY GROUP NO Of DWELLING UNITS <br /> - <br /> ALLOWABLE/ACT ALr. <br /> PLUMBING <br /> SIZE Of BLDG NO OF STORIES j BySMT. OCC LOAD MECHANICAL <br /> 39A/J 2 La 20 --- — <br /> HEIGHTMAMMON OTHER <br /> FIRE SPRINKLERS REWIRED I:,YES II) STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE _- _- <br /> APPLICATION ACC BY PLANS APPR BY PUBLIC WORKS 1� /1 <br /> — 0i\ -N -7--4-)- TOTAL EV IC SC? <br /> c)1 `I2 <br />