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APPLICATIOv,d FOR CONSTRUCT► JN PERMIT eveEecc <br />the Evergreen TO BE COMPLETED IN IkK—PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: ifGAS ❑ ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 b <br />DEMOLITION COMBINATION '✓ BUILDING MECHANICAL pPLUMBING SIGN_ <br />OWNEH GYr.�rrtlll �. MAIL ADDRESS CITY ZIP PHONE <br />DALI-1bill IAN 3,119 Br-I-L AV CVEiZETT 9swi ? 8 0,-&8 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />SELF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />CLASS GE WORK <br />NEW✓ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />r <br />CONTRACT PRICE OF WORT: r, Doi i IFS0 <br />CONTACT PERSON AND PHONE NO <br />ECJIA )J <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED S(L F-1 , x 1,3Z I <br />MID Z CAV- CRF.A E FAMILY ROOM d. Do2MEK <br />PROPOSED USE OF BUILDING <br />L I VIN� SPAC C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOL '_ LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RUW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR CA AUTHORIZED AGENT DATE <br />/ i /��� <br />Af PLICANT CITYBUSINESSLICENSE NO ANDBUSINESSNAME <br />LEGAL DESCRIPTON OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />/O 11 <br />LOT BLOCK _-� OF cCE)'=Hiu. ADp lnAl <br />JOeXC& .7> <br />i <br />Rw or-.L�_1C - <br />1 <br />PROJECT ADDRESS <br />3 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-R T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD _ <br />T <br />LAUNDRY TRAY <br />WATER HEATER <br />If <br />CLOTHES WASHER <br />157 <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINK114G FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />i— <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSE !BACK REAR SETBACK <br />?Q N <br />USE ZONE LOT AREA <br />TYPE OF CONTS ALLOWABLE TYPE Of CO NSi A( <br />A 1 \/ -A 1 <br />VACANT SITE <br />XCOWH I "0IrrtlllWATS <br />SIZE OF 01 NO OF STORIES BASEMENT <br />Cqq-f ADONt <br />�jj sf can _ 2 D <br />OCCUPANCYLOAD FIRE SPRNKI ERS REO'D HEIGHT LIMITI1IOON <br />Nil I C RIC <br />Iq <br />REA F ASPRINKLERS A. .V Attr. <br />(TAKE BY PLANS APPROVED BY CITY OF EVERETT <br />LOCAL <br />TAX CODE SLES 3105 <br />PLAN CHECK N <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />9 (Pv 1 RECEIPT6,Iv—) <br />y <br />TOTAL <br />