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....-. everett <br />APPLICATIO.4 FOR CONSTRUC7.JN PERMIT <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: ❑GAS UELECTRIC U _ 1 <br />BUILDING DEPARTMENT — <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITV ZIP PHONE <br />BDEIN� H/�rN aAY ASSM80 8co4 4o-Zs SVAF ,&r . yYZOl ZZ6-I�6A� <br />TENANT MAIL ADDRESS CITY DP PHONE <br />ARCHITECT OR DESIGNE R MAIL ADDRESS <br />ZIP PHONE <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />AUS7)N COMPANY <br />/0/5-47a 41fv <br />g E owA. 9#2oo <br />266-Ni%oo <br />223-01-Au-ST-IC73wj <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE E <br />COSCof1ft ileo7F~ <br />/09/04177w <br />NE K/RaAAVN4 40o3i <br />W-W4j <br />toSCoFPIioNM <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />I ADDITION 1 1 ALTERATION REPAIR DEMOLITION . WOODSTOVE/FRPL INSERT U BUILDING RELOCATION <br />pmz <br />CONTRACT PRICE OF WORN N#4PRiA/kl, <br />CONTACT PERSON AND PHONE NO <br />L S#I iW 9 2 7- 96 5'4 <br />DESCRIBE WORK AND SOUARE FOOTAGE IAVOLVED <br />PROPOSED USE OF BUILDING <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 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 ON AUTHORIZED AGENT DATE �d ^z <br />V e ` d 4' <br />"� Aff �_ 174_ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK - OF <br />PROJECT ADDRESS / <br />.9 003 t�t��/A0 YW, O -�i/ <br />J <br />APPLICANTS CITY BU50lE534C':NSi NO :Ap11U5PVF i5 NAMF. <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 (TOILET) <br />A/C—NHNDLG 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 />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />WATER HEATER <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 />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />s / s <br />zti3 ;ac <br />c <br />14G Aso <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />__ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAIT CHECK NUMB E[1 <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SIIE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of CONES ALLOWABLE <br />TYPE Of CONSIACTUAI <br />IACCPMrtr <br />c4AP <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECIIANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO D HEIGHT LIMITATION <br />OTHER % _.,_,/z, <br />93 <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />rL 5APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />{ 1� <br />LOCAL SALES <br />TAX CODE IS <br />3105 1 <br />TOTAL <br />9-3 �,4, <br />