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APPLI6: IIIION FOR CONSTRUiCTION <br />PERMIT <br />the Evergreen ie <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER n MAILADDRESS CITY�y ZIP PHONE <br />( Ap P� T I V✓n LV(re� 4 `ISx�7 <br />GnPncarL re Pr LPs 691"t L�Pr�rrr� .� <br />TENANT MAILADDRESS CITY ZIP PHONE <br />1 <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />' earl L•Arse� <br />i <br />y MECHANICAL CONTRACTOR MAILADDRESS CITY 21P PHONE LICENSE <br />AFt'It t S}N}t S/M PQ.QDx IS,78 Fyect+ gmot ?Sl•SIN E-tFAC9•-5)2147 <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />I <br />CLASSOF WORK <br />❑ NEW ❑ ADDITION 12. ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLINSERT Cl 13UILOING RELOCATION <br />i <br />I <br />r <br />TENANT IMPROVEMENT On INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />J ve l"f fP,' ra �r ?s Z •311 `� <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />N.v.A-Q_ <br />PROPOSEErD�((`USE OF BUILDING <br />(94,1c I- S AC <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 THIS TYPE OF WORK WILL BECOMPLEfEDWITH <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ,Ila-r ���- ` a - �g <br />LEGAL DESCRIPTION OFP OPERTY(SHOWN BELOW ORATTAC/1 FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />6.11-1 fv(r rPrn wa <br />gPPLI TS CITY BUSINESS LICENSE O. ANp BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPEOFEGUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —AIHNDLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA rpm <br />'1 <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHESDRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />R,`NGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACES CHIMNEY_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEATPUMP <br />BACKFLOW PREVENTERS <br />% <br />GAS PIPING FA(`n µ.•✓ T <br />ROOF DRAINS — RAINLEADERS <br />EXFIAUSTFAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />I <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR 5ETBACK <br />SIDESETBACY. <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPr NO. <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />1) YES Cl NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGROUP <br />NO, OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLOC. <br />NO.OFSTORIES <br />BSMT, <br />D Y <br />ON <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED DYES ONO <br />HEIGHT LIMITATION <br />1 <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />