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E�1 <br />APPLICa (ION FOR CONSTR"TION <br />PERMIT <br />the LvergreeR <br />CITrvPrDll <br />everett <br />e <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNER <br />MAIL ADDRESS Di1Y ZIP PHONE <br />P✓tfiltTtfu11Z, J'%%aF4cT <br />R?oV Aud. CootAeTr. <br />TENANT <br />MAILADDRESS - CITY ZIP PHONE <br />,4 WrJA so <�.l - <br />re)c flg r7 S 5 , 0 N I- 2 �� - <br />ARCHRECTOR„DESIGNER <br />1 <br />MAILADDRESS CITY ZIP PHONE <br />GENERALCONTRACTOR <br />MAILADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAILADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACT R / <br />/'/L L:�cU< (�itci A. <br />MAILADDRESS Q CITY ZIP PHONE LICENSE <br />QKy pa �x �a9 /I%AFYSUi/�C <br />CL�S OF VARK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />9 <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF Vl K <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WOR AND SOUARE FOOTAGE INVOLVED <br />PBOPo EDu EOF BUILDING <br />GL <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 />ORI )INANCES 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 AUTHORITY 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 1 HE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRJCTORS LAW 18.27 RCVJ AND <br />296,200 WAG <br />SIGN ATURE OFCONT TOR AUT PORED AGENT DATE <br />X r <br />�p TS CITY BU NESS LICENSE OAND ESS NAIJIE <br />LEGAL DESCRIPTION OF PROPERTY ISNOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK_ OF <br />PROJECT ADORERS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPIi OF COUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG ONITS — M P <br />_ <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS —BT.U. MEA <br />_ <br />'I <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 6 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />/ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING _ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC) <br />_ <br />SUBTOTAL <br />$ <br />SUBTOTAL 8 <br />_ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE 5 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEF. <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />O YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— <br />TOFCONST <br />YPE <br />ALLOWABLEJACTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO.OF STORIES <br />BSMT. <br />D Y <br />❑N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REWIRED OYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PUNS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />