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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•RBTO <br />OWNE11 <br />APPLIIGATION FOR CONSTA:/CTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />o (o <br />CITY ZIP PIIONE <br />v Olub. Ei/&l;= 338 -3648 <br />CITY ZIP PHONE <br />f,'o FBb,C a4l 1-YIM41640 9 %OV6 776_-_&?ff <br />MAIL ADDRESS CRY ZIP NIGHE LICENSE <br />PLUMOINOCONTRACIOR MMLADDRESS GTY ZIP vilo—la LICENSER <br />9 NEW ❑ ADD'( ION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPRCNEMEN' OA/NTEIIORREMOVELPNLY <br />o_ m <br />CfiNTRRCT Pr.IG" JF WOR 75 <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />INS L I1.4lLUN1A/S sIr vrw <br />PROPOSFU USE OF BUILDING <br />(ERN <br />_ <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 />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT GOES NOT <br />PRESUME TO GIVE AUTHORITY TO'+,CLATE 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 THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION 15 MADE <br />AND I COMPLY WITH Tt1E STATE CONTRACTORS LAW 1627 RCW AND <br />296.200 WAG <br />SI GNATURE OF CONT FACTOR ON AUTI IORIZED AGE NT DATE �6j <br />iEGAL DESCRIPTION OF PROPER" (SHOWN BELOW OR ATTACH FOUR CAPIEBI <br />I,oT BLOCK of — <br />— <br />PRWECI ADDRESS <br />Woo& T l <br />APPIIC NIBCITY BUSINESS <br />/6�z <br />SE NOA BU81NES5 NAME <br />pjEZR� w9M S/GN 60, INC. <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 — ArHNDLG UI.i!S—HP. <br />SATI{TUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVA, ORYVASH BASIN) <br />UNIT HEATERS —BT.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACEINS T <br />FLODR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GASPIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE— BAR ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL 4 <br />_ <br />PERMIT <br />& <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />15 . <br />LOTAREA <br />VACANT BITE <br />O YEB0 <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OFPE OF CONST. <br />ALLOWABIE/ACTUAI <br />OCCUPANCYOROUP <br />NO OF DWELLING UNITE <br />PLUMBING <br />_ <br />SIZE OF BLDO <br />NOOF STORIES <br />USMT. <br />O I <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED O YES 0 NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION MCC BY PLAN9 APPq <br />/J <br />STATE ENERGY SURCHARGE <br />PUBLI.' WORKS <br />TOTAL <br />