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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIC ION FOR CONSTRUCTION <br />PERMIT <br />everett <br />e <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />MAILADDRESs CITY ZIP PHONE 53--7?-2 1� <br />ARCHITECT OR DESIGNER <br />PHONE . <br />I <br />MAIL ADDRESS <br />CITY ZIP <br />...... .m <br />PHONE LICE N5E • I <br />U NEW AUUNIun u ._. .......... <br />TENANT IMPTIGENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WOHVZ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOWED <br />PROPOSED USE OF BUILDING <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 BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NO LTHE GRANTING OF A PERMIT DOES NOT <br />LEGAL DESCRIPTION OF PpOPERTYTSHOWN BELOW OR ATTACK FOURCOPIES) <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OF <br />ANY OTHER STATE OR LOCAL LAW REGUL\TING CONSTRUCTION OR THE PER- <br />LOT BLOCK <br />FORMANCE OF CONSTRUCTION. THAT I ANT 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 1827 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRAC70R OR AUTHORIZED AGENT DATE <br />�/2��� <br />PROJEC/7 ADDRESS <br />�PLICANTS CITY BUSINESSNAME <br />r/ � / <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 />A/C—A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS— &LU, M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—B.T.U. M <br />SHOWER <br />CLOTHESDRYERS <br />KITCHEN SINK& DISK <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />' DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />$ <br />iD <br />L S <br />50 <br />OQ <br />PERMIT <br />$ <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK, <br />PLANCIIECKNUMBEp <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />O YES O NO <br />BUILDING <br />IYPEOFCONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />.7 <br />ALLOWABLEIACTUAL <br />PLUMBING <br />J G <br />Do <br />SIZEOF BLOQ <br />NO.OF SIORIE9 <br />USJIA <br />OCO LOAD <br />MECHANICAL <br />OILT. <br />50 <br />OTHER <br />ON <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIREO O YES D NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC. BY PLANS APPH BY <br />MC <br />TOTAL <br />J 1 <br />C�., <br />N <br />