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11 <br />u <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICAI oON FOR CONSTRUE (ION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER <br />MAIL ADURLSS <br />CIY ZIP PHONE <br />RErr wog MPKK�T� <br />(aKcy�o <br />av� "pgoPN� <br />TENANT <br />MAIL AODREBB <br />C11Y ZIP ONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY 21P PHONE <br />AVF T9" O> W_' 2i'ig� o8 <br />GENERAL CONTRACT i <br />_ <br />MAILADDR `S <br />yCITY ZIP PHONE ULENSEA <br />f��•�b <br />R L E erEsl.i <br />�.�EN% /7�iC1� <br />MECHNI1E IT264h <br />MECHANICAL LONTRAGLOR <br />4 <br />MAIL ADDRESS <br />CITY ZIP PHONE LIL'ENSE• <br />II <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION *ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OP INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />Qr <br />Z D— <br />CONTACT PERSON AND PHONE NO <br />SW SORE FOOTAGE INVOLVED <br />DESCRIBE WORK AND <br />f A4 (/tom 70�0 <br />It <br />N' <br />PROPOSED USE OF BUILDING T <br />I HEREBY CERTIFY THAT I HAVE READAND EAAMINEDTHIS APPLICATIONAND <br />KNOWTHE SAMETO BE TRUE AND CORRECT. ALL PROV0ONSOFLAWSAND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETH ER SPECIFIED HEP.EIN OR NOT. THEGRANTING OF A PERMIT DOE6 NOT <br />PRESUME TO GIVE AUTHOPITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF 11F AL f. AU1R RIZED AGENT DATE / ��— <br />X <br />LEGAL DESCRIPTION Of PROPERLY(SNOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK-- OF <br />PROJECT ADDRESS <br />APPLICAN USINESS LICENSE NO AN(]BUBINEBBNAME <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/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— BT.U, M EA <br />LAVATORY (WASH BASINI <br />UNITHEATERS—B.T.U. M <br />_ <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK(SERVICE— BAR, ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />5 <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />d� 6 3 <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT <br />❑ YES NO <br />t FEES <br />VALUATION <br />FEE <br />BUILDING <br />I1 Q-1 <br />1jj <br />It <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />+� <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. f• <br />780 ,Ty <br />NOOFSTORIES <br />' <br />I SSMT. <br />TY, <br />V�+ <br />OLCLOAD <br />I (0 <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED AES O NO <br />HEIGHT LIMITATION <br />u K <br />STATE BUILDING SURCHARGE <br />J <br />S V <br />APPLICATION AM BY III <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKSEl <br />TOTAL <br />•'1 <br />'T J�C <br />- <br />CJ <br />