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APPLILe4TION FOR CONSTRJCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />/ rlelrU <br />everett► <br />BUILDING DEPARTMENT <br />259•8810 <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />LR MAI ADDRESS CITY 11P PHONE <br />ZIP <br />TENANTI .y�[•Lp AIL�AOD ESS 1•y,/Ly01 �■]6!��• jyT `��f�) <br />AO IT CT ROESI N H AIL 1100 �•' GITY 21P PHONE <br />O� CON OTOR I , It AUONE55 CIfY ZIP PNONE 1 LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IT <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL INSERT -fief BUILDING Alit OCATION <br />TENANT OR INTERIOR REMODEL ONLY <br />RACTIMPROVEMENT <br />OF <br />NTIUCT PRICE OF VgAK <br />D SCRIEE KANDSOUAREF T E WI D <br />/r�_�eor - . k rd�� �(� '�Q� <br />TROTS DusE �F lAntol c <br />C(��GT PER9 NANO PNIINE NO _• � �� <br />VIA 3UAf 1L <br />Y1�r�--'�, e eV ----- <br />THEREBY CERTIFY THATI 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 />W HETHERSPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL L#W REGULATING CONSTRUCTION OR THE PER. <br />FORMANCE OF CONSTRUCTIOIN, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO PERFOR HE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH TH BtE TRACTORS LAW 18.27 RCW AND <br />SIGNAT 0 WAG <br />SIGNATURE OF ONTN O TyOAIZEO NT DATE <br />tl\ • ��� `� <br />LEGAL DESCRIPTION OF ERTYISNOWN BELOW OR ARACH FOURCOPIEW <br />LOT BLocK___OF <br />•,nT �� 4 -n <br />Y <br />AiA <br />PROJECTADDRESS <br />2way <br />APP CANT CITY SIN ESS <br />ICENSE NO A D BU91NES9 NAME <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 />_ _ _ <br />_ <br />A/C - A/HNDLG UNITS - HP. <br />BATHTUB <br />FORCED AIR SYSTEMS- BTU. M EA <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS - BTU. M <br />CLOTHES DRYERS <br />SHOWER <br />_ <br />_ <br />_ <br />KITCHEN SINK A DISK <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRVTRAY <br />_ <br />WATERHEATER <br />CLOTHES WASHER <br />__ <br />STOVE <br />URINAL <br />_ <br />_ <br />_WOOD <br />METAL FIREPLACE It CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />_ <br />_ <br />EXHAUSTFAN <br />SINK (SERVICE - BAR ETC) <br />_ <br />_ <br />SUBTOTAL $ <br />SUBTOTAL S <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S <br />FRONT SETBACK <br />' <br />REARSF.TBACK <br />212 <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Z/L s <br />FEE <br />RECEIPTNO. <br />USEZONE <br />' <br />TYPEOFOONST. <br />LOTAREA <br />VACANTSITE <br />❑ YES �O <br />FEES <br />ALUaTION <br />FEE <br />BUILDING <br />_ <br />ALLOVABLErACTU \/3- <br />OCCUPANCYGROUP <br />B - Z <br />NO NO OFOWELLINO UNITS <br />'a— <br />-__ -__ <br />PLUMBING <br />SIZE OF BLDG <br />NO.OFSTORIEB <br />I <br />l <br />BSMT. <br />I Y <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REWIRED ITYE8 O <br />HEIGHT L,IMITATAI N <br />t`I /'4 <br />STATE BUILDING SURCHARGE <br />Y <br />S a <br />APPLICATION ACC BY PLANS APPR. 9 <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />S U <br />F1/�Y'Ll:.ti.lTl I(11: ._rT 1 �/✓)1//�L�L��� <br />