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I <br />1 <br />1 <br />1 <br />I <br />i <br />11 <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPAnTMENT <br />259-8810 <br />APPLiCi' IKON FOR CON sTRL*w'f,7mN <br />PERMIT <br />TO BE COMPLETED IN INK— PLEAL?E PRINT <br />OWNEn MA.LADURESS CITY ZiP PHONE <br />Ell <br />GENERAL CON TRACTOR MAIL ADDRESS <br />CITY <br />21I' <br />P14014E <br />LICENSE@ <br />�t�S_�yZQT�a CL7�lS» <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADD ESS <br />OTT <br />21P <br />PHONE <br />PLUMeINO CONTRACTOR MAILAUDRESS CITY ZIP PHONE LICENSE <br />5!N <br />rI r1 rl . DAnnM n nPPA1G n n:rinLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPRO-EMEN I OI OR INTCRION REMODEL ONLY <br />CONTRACT P91CL OF WORK <br />CONTACT PERSON AND PHONE NO <br />— <br />DESCRIBL WORK AND SQUARE FOOTAGE INVOLVFU <br />PROPOSED USE OF BUILDING <br />— <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLIZATIOII AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVIS10NS')F LAWS AN D <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THEGRANTINGOFA PERM T DOES NOT <br />PRESUME TO GIVE AUTI IORITY TO VIOLATE OR CANCEL T11E PRO IISIONS OF <br />ANYOTHERSTATE ORLOCAL LAW REGULATING CONSTRUCTION GRTHEPER- <br />FORMANCE OF CONSTRUC110N. THAT I AM AUTHCIIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />0 WAG <br />SIOIUTUn�� OR AUlHkr4UZEOAGEHT DATE � <br />SIGNATURE <br />X <br />LEGAL DescRlPnoN OF PnovERtt lBHann BELowoR AnACN FOUR coPlEs. <br />LOT BLOCK OF <br />— <br />PROJECTT'/' I_AUDRESS <br />I <br />PLUMBING <br />APPLICANTS CITY SUSIGF.S LICENSE NO AND BUSINESS NAME <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 —AIHNOLG UNITS—H.P. <br />_— <br />BATHTUB <br />___ <br />FORCED AIR SYSTEMS —BTU. MEA <br />— <br />_ <br />LAVATORY(WASHBASIN) <br />UNIT HEATERS—BT.U. M <br />— <br />SHOWER <br />CLOTHES DRYERS <br />_- <br />KITCHFNSINKBDISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />— <br />URINAL <br />METAL FIREPLACES CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEATPUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />— <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE BAR, ETC) <br />— <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUNCHECKNUMBER <br />PEE <br />RECEIFF14M <br />USEZONE <br />LOTAREA <br />VACANTSIIE <br />DYES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLEIACTUAL <br />OCCUPANCYGtIOUP <br />NO.OFDWELLINGUMTS <br />PLUMBING <br />SIZE OF BLDG <br />NO IF STORIES <br />BSMT, <br />ON <br />OCO LOAD <br />MECHANICAL <br />_ <br />OTHER <br />FInE SPRINKLERS nEOUInED ❑ YES ❑ NO <br />HEIGHTLIMITAPON <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLNNSAPPn. DV <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />