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cif <br />APPLICATICoev FOR CONSTRUCT ► JN PERMIT <br />The Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•BB10 <br />DEMOLITION <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS U ELECTRIC U <br />COMBINATION BUILDING <br />everett <br />e <br />PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />BOEINb H/Q+// SAY ASS&OLY SW +O-Zs E✓��rr,w�4. 9rao1 ?Z446oz <br />TENANT MAIL ADDRESS CITY ]IP PHONE <br />ARCHITECT OR DESIGT ER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />AUSnN fOMPANY <br />MAIL ADDRESS <br />/0/s-47t4T &F,49jkt <br />CITY ZIP <br />lwg. 982yp <br />PHONE LICENSE) <br />266.66" 223-01-0-04171wj <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE - <br />COslv f/RE iW?F4l&W <br />/09/O-/I7m <br />XAF- kiRAVA004 <br />VIOi? 837-IW* COSCOMIONM <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />C SOF WORK <br />NEW I ADDITION I ' ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT L; BUILDING RELOCATION <br />ix <br />CONTRACT PRICE OF WORK IVA SPR.rNk[. <br />CCNT PERSONANDPHONE NO <br />27-46 S <br />DESCRIBE WORK AND SQUARE FOOTAGE 1111VOLVED <br />0* ZONAES# 1 i <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 1 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 3�9/9z <br />X Ae <br />4C*kp_fAo 7no_N_ 1� 024-14 I ¢ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <br />PRaecT ADDR:ss <br />3D o J (J _ L -/Q 2 s— <br />—.-- <br />F PPLICANTS CITY BUSA:E SS LICI`.NSF NO WDBU>b\EaS NAME <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 />AIC—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU 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 />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & 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 />SINK (SERVICE —BAR. ETC.) <br />bzl <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />_ <br />TOTAL FEE $ 1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETDACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />•3 <br />FEE <br />%LaS. <br />RECEIPT NO <br />6,0 6n ,Z <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUAT;ON <br />FEE <br />BUILOING <br />---- --- <br />—"^ <br />_ <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />MNIM", <br />Ao VIb.L1i40U415 <br />s" <br />PLUMBING <br />SREOFBUDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLEDS REDO HEIGHT (IMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS PPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />.� <br />TAX CODE IS 3105 <br />TOTAL <br />3 3c Sa <br />