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lop, <br />APPLICATIOb,A FOR CONSTRUCT6 oN PERMIT <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />Me Evergreen <br />CITY OF <br />everett I HEATING SYSTEM: I, GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />C1 DEMOLITION I i COMBINATION i BUILDING I !MECHANICAL '.PLUMBING ! I SIGN <br />OWNER MAIL ADORF.SS CITY 71P PHONE <br />FVae,t oo( ne,�' t 4.7w Gold EyereA cfpw3 33`i-435o <br />TENANT MAMA RE CITY ZIP PHONE <br />:,��►s _/�1�: �C/� S_c�_ <br />ARCHITECT OR OESIf1JER MAMA ORE55 CITY ZIP PHONE <br />r-iv► c i"i"P��s 61312 E } 'Witi P*, F Vy4i a5201 258-C �II <br />GENERAL corrrAACTOR MAIL ADDRES CITY ZIP PHONE LICENSE <br />MECHANI ALCONTRAOTOR ILAODR .❑ ZIP PHONE LICENSE( <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE( <br />n NEW I I ADDITION (-I ALTERATION I I REPAIR 1 1 DEMOLITION I_I WOOOSTOVE/FRPL INSERT C7 BUILDING RELOCATION <br />sA <br />fCPRICE <br />CONTRACT PRICE OF�TVWO N <br />CONTACT PERSON AND <br />IiN1�C=�•'••yd/ 1 <br />DESCRIBE "P!IK AND �J�ARE FC`OTAG INVOy�ED t W6 <br />PROPOSED USED BUILD( <br />G <br />G <br />�0(ODiVt<1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BL 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 LOCAL 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 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE ryAy�J <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />IOr BLOCK OF <br />-' <br />MNuI <br />P <br />ICAI SRITY - <br />APPLU ESS LICENSE <br />r/♦� <br />ANDBUSINESSNAME / <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. _ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD _ <br />T <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 />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN_ <br />_ <br />SINK (SERVICE -BAR, ETC.) <br />I <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE ? 1 <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK S1DE SETBACK PLAN CHECK IjIyMPfTR FEE RECEIPT NO <br />S S 2�_ J'Od 1 _ <br />USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br />_ l 1 7JO BUILDING I 1 <br />TYPE OF CONTS. ALLOWAOIE TYPE OF CONS(. ACTUAL OCCUPANCY NO OF MULL 4GUNi6 <br />�01''P PLUMBING <br />SIZE OFBLDG. NO. OF STORIES BASEMENT MECHANICAL <br />&JU SP l Nv --- <br />OCCUPANCY LOAD FIRE SPRNKLERSREOD HEIGHT LILIITATIO� ADDITIONAL PLAN CHECK <br />J a OTHER <br />REASON FOR SPANJKLERS <br />STATE BUILDING SURCHARGE v� <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORDS <br />( LOCAL SALES T— <br />Qly���G� J� TAX CODE IS 3105 TOTAL > Sc <br />