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Me Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLIC-"AON FOR CONSTRL'A ;TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />rA <br />GENENKConTRAeiOj/R - MAILA4DRES5 CITY ZIP rnMNK u�cna• <br />%NIC L ONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEMlEI>• <br />PLIMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />CLASS Of WORK <br />Fl rV( AnnITInM r1 AITPBATInN 171 RFPAIR ❑ DEMOLITION ❑ WOODSTOVE'FRPL. INSERT ❑ BUILOINGRELOCATION <br />TENANT IMPROVEMENT OR INTERIIO7R REMODEL ONLY <br />CONTRACT PRICE Of WORK �.S o__L�yL_Li <br />DESCRIBE WORK AND SOW RE FOOTAGE INVOLVED <br />Aotd(+Ibo C yu�eye + bL,H wN rtdr o a ZGAz l ndtil <br />CONI+P PEPSO1 N ANID PHONE NO / <br />C Fh{��—?—` <br />) <br />PROroSEDUSEOF BUILDING ! <br />S�n�1e eF MN N <br />t*V)!l c 4f I <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 IRIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE ORLOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS <br />THE STATE CONTRACTORS IH`APWPL1827ORCW ADE <br />AND IROPERTY COMPLYTWITHPERFORM <br />ND <br />296200 WAC. <br />SIGNATURE Or CONTRACTOR OR AUTHORVCD�A(�OE/Nt DATE <br />APP`� -V O <br />LEGAL on OF ?ISHrnvN BELow OR ATTACH rouR cvPles <br />LOTBLOCK OF <br />/(��• <br />Cl tod `-' �-��=T�n� `7— <br />p <br />DI` V N <br />PROJECT AGGRESS <br />PLUMBING <br />APPLICANTS CITY BUSINESS LENSE NU. AN MESS NAME <br />LICENSE <br />MECHANICAL <br />No. <br />TYPE OF FIXTURE OR II EM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />— <br />A/C — A'HNDLG UNITS —H.P. <br />_ <br />BATHTUB <br />— <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />�r <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOODSTOVE <br />_ <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FI" EPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF D14AINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE— BAR. ETC.) <br />SUB TOTAL <br />SUB TOTAL E <br />PERMIT <br />S <br />_PERMIT E <br />_ <br />TOTAL FEE <br />E <br />TOTAL FEE $ <br />FRONT SETBACK <br />Zm" <br />REAR SETWCK <br />-? <br />SIDESLIBACK <br />L' <br />PLAN CHECK UMBER <br />? <br />FFE <br />1�3% <br />RECEIPT NO. <br />IL% Z <br />USE ZONE <br />�_1 <br />LOT AREA <br />0YEES SHE <br />�Jb <br />r <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/ I <br />TYPE OF CONsi. n / <br />ALLOv'ASLE'�i <br />SIZE OF BLDD. Fv <br />OCCUPANCY OPOUP <br />—3 <br />NO. OF SIOBIE9 BSMi. <br />D r <br />NO, C4 D\YELLING UNITS <br />OCAD <br />� <br />PLUMBING <br />MECHANICAL <br />OTHER <br />b� <br />FIRE SPRINKLERS REOUIRED DYES 0 <br />HEIGHTLIMOATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />'(�1(� 1 <br />\'Q\ �✓ <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />/� <br />0 <br />\ <br />t/„J <br />