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APPLICJ6 60N FOR CONS'F/ LL,TION <br />PERMIT <br />tho Evergroon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />I <br />OE/NDERALCONTRACTOR MAILADDRESS CITY ZIP PHONE <br />1 Carl L-Ars e• <br />i <br />MECHANICAL CONTRACTOR MAILADDRCSS GTY ZIP PHONE <br />kve erg 1 <br />sIn1L VIL, (.2 60x sae Eyeft—F} -ja.1o6 •3111 <br />PLUM[iIN-CONTRACTOR MAILAUURESSC17Y PHONE <br />I <br />1 <br />i <br />2 <br />1 <br />1 <br />I <br />ARCHITECT OR DESIGNER MAIL ADORE39 CITY ZIP PHONE <br />❑ NEW V ❑ ADDITION a ALTERATION ❑ REPAIR I —I nEMrn mnM rl WnnnRTnvcmnn, u,cen. f"I <br />.rR -65 - S 12I f7 <br />UCENS.: <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />I-ONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />N•v. A.e., <br />CONTACT PERSON AND PHONE NO•{ <br />J9e �l rPtreL 'Jr, <br />PROPOSED USE OF BUILDING <br />t <br />(74 Ic e- Sp AC IL <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 NOTTHE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER. <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY T 0 PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIGNATURE FOFCONTRAOCTJOTT On A117HORIZEO AGENT DATE ry <br />II� 1'`^'�t l P �8 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES- <br />LOT CLOCK OF <br />PROJECTADORESS <br />APPLI la AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER fLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA 12fPP <br />'1 <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SIN'C& DISK <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />rj, <br />GAS P,PING FArn +r 14,•,i T <br />RUOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE— BAR, ETC.) <br />SUB FOTAL <br />$ <br />SUB "DOTAL $ <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECLIPI NO, <br />USEZONE <br />TYPE OF CONST. <br />ALLOWABLEIACTUAL <br />LOTAREA <br />OCCUPANCYUROUP <br />VACANTSITE <br />O YES D NO <br />-NO. OF DWELLING UNITS <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />SIZE OF BLOM <br />NO.OF STORIES <br />BSMT. <br />O Y <br />❑N <br />COCO,LOAD <br />— <br />MECHANICAL <br />- <br />_ <br />FIRE SPRINKLERS REQUIRED 0 YES ❑ NO <br />APPLICATION ACC BY PLANSAPPRBY / Y <br />NEIGH 'LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />FUEL C WORKS <br />- <br />TOTAL <br />