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APPLICirfION FOR CONSTRU&ION <br />PERMIT <br />the Evergreen L <br />lt <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CRY ZIP PHONE <br />o <br />l NI�►tC>o Ti'�!� Co Itorf $T WereffyPZo/ <br />TENANT MNL ADORE59 CITY ZIP PHONE <br />S1 <br />CHITECTOR DESIGNER MAIL ADDRESS CITY ZIP <br />MPHONE <br />1 <br />— t.,n •^� ___.._ I'"I _.-..... .�....� I —I ..�nnncmvcicool INRFRT ❑ RWLOING RELOCATION <br />U NEW U ADDITION ALI tHR11Vry �-A n -- - <br />TENANTIMPROVEMENTORINTERIOR�TREMODELONLY <br />— -'---- <br />CONTACt PERSON AND PHONE N/Q/ <br />���/ <br />// ���, <br />e1 �fF/ - <br />CONTRACT PRICE OF WORK /VT <br />DESORIBE WORKANO SQUARE FOOTAGE IINVOLV <br />;A'!!-J�ff4"r L-OH <br />PROPOSED USE OF BUILDING <br />m P� I�ODFh <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />• <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />`/ <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITHWHETHER SPECIFIED HEREINOR NOT.THEGRANTING OFAPERMIT DOES NOT <br />LEGAL DEC IPilO PE OF PRORtt(SHC WN BELOW OR ATTACH fOUR COPIES( <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />LOT BLOCK OF <br />CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />FORMANCE OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 16.27 RCW AND <br />DATE �. •6 <br />29B.20/TSCITYBUSI�IJES <br />SIGNATRATOR ON THOR �EDAGENT <br />XPROJE <br />�o I��Y�s%a�'Uvr�ff yS�i <br />TAODRES9 <br />APPUCGEN9E NO. AND BUSINESS NAME <br />MECHANICAL :� <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. OF EQUIPMENT <br />FEE <br />A/C—fVHNITS—H.P. p <br />WATER CLOSET (TOILET) <br />FORCED A—B.T.U. MEALAVATORY <br />BATHTUB <br />:SYSTEMS <br />UNIT HEATB.T.U. MSHOWER <br />(WASH BASIN) <br />CLOTHES S <br />KITCHEN SINK8 DISP.VENTILATI <br />DISHWASHER <br />RANGE HOOD <br />-- <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />_ <br />WOOD STOVE <br />METAL FIREPLACE B CHIMNEY <br />URINAL <br />_ <br />FIREPLACE INSERT <br />D91NKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOFDRAINS— RAINLEADERS <br />EXHAUSTFAN <br />— <br />SINK (SERVICE —BAR, ETC.) <br />— <br />SUBTOTAL $ <br />SUBTOTAL <br />S <br />PERMIT $ <br />PERMIT <br />8 <br />TOTAL FEE <br />s <br />TOTAL FEE S <br />FRONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER FEE RECEIPT NO. <br />uSEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TYPEOFCONST. <br />OCCUPANCY GROUP <br />OFDWELLING UNITS <br />----'- <br />ALLOWABLEIACTUAL <br />PLUMBING <br />_ <br />SIZE OF BLDG. <br />NO.OF STORIES <br />ROSY T. <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />ON <br />HEIGHT (IMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIREO 0 YES O NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC BY PLANS APPa BY <br />TOTAL <br />LI. <br />