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APPLIC "MON FOR CONSTRC7ibTION <br />PERMIT <br />Ule Evergreen DvereU <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.81110 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />..a. — I I -.. - / �< C_1 _ RFT I 1=VUL OIexloB <br />ARCHITECT OR DESIGN ER LIAR. ADDRESS CITY ZIP FIIONE <br />pYKI.r-I11J AF(:HI <br />ERALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />n i .___,.ITI, :ont.f71\1'-!. o.TH R-IOU Ri=nmo]1-) CI¢Gj2 R�_%l' IL i%%_alp_vQ7al..l_1g <br />OlVM1�tC1'iCG-1F1t�ilCfll_11::G AIi14S'(o.o IiAVL W, ;4 20,S 00oKA1_111�15FCCcJ)C, g6o4z'17L(.egL)I OL4NPMI17001 <br />PLPMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE- <br />r-I f-I ., f l ncurn nlnv I7 wnnDSTOVEIFRPL INSERT 0 BUILDING RELOCATION <br />M NEW U AUUIIKJIN u AUE;; ; <br />_. ,.... _ __...__..._.. <br />__ <br />PERSON PHONE NO, <br />TENANT IMPROVEr.ILNT OR INTERIOR REMODEL ONLY <br />pp �/'� d0 <br />CONTRACT F W 5 c'L - <br />�C�O�NT�A�C�T �AND <br />� <br />r1CMl-1�L'�1�I� <br />ORKARICE <br />SQUAORKRE <br />OESGRIBEWORKANOSOUAREFOOT GE INVOLVED <br />qq 5 S, F. <br />PROP09E0 USE OF BUII.DINQ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW TI4E SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AN D <br />�_ I <br />R A <br />ORDINAL: GOVERNING THIS TYPE WORN:WILLBE COMPLETED WITH <br />WHETHEHSPECIFIED HEREIN OR NOT, THE GRANTING OFAPERMIT DOES NOT <br />LEGALOES91 NOFPROPERTYISHDIYNOELOWOn ATTACHFOURCOPIES) <br />PRESUME TO 3P: E AUTHORITY TO V;CLATE O^ CANCEL TI IC fITOVISICt:O OF <br />LOCAL LAW EEGULATINGCONSTRUCTION ORTHE PER- <br />LOT BLOCK OF <br />ANY OTHER STATE OR <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 WAG <br />SIGNATURE OFCONTRACTOR OR AUTHORIZED AGENT DATE <br />1 / <br />'�'C — <br />APPLICANTSCiY'USIN SIICENSE OAND BUSINESS NAME <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIR:: _ENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A!HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—_B.T.U. MEA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE& CHIMNEY <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAI NLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />5 <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />FRONT SETBACK REAR SETBACK <br />SIDE SET BACK <br />PUN CHECK NUMBER FEE RECEIPT NO. <br />USEZONE <br />LOT AR EA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YE9 ONO <br />BUILDING <br />ttPE OF CONSi. <br />OCCUPANCY GROUP <br />NO.OF DWELLING UNIT <br />S <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF CLOG. <br />NO.OF STORIES <br />BSYT. <br />OCG LOAD <br />MECHANICAL <br />GTIIF' <br />❑N <br />HEIGHTLIMITALION <br />FIRE SPRINKLERS REQUIRED ❑ YES ONO <br />STATE DIiILf ::IG SURCHARGE <br />STATE ENERGY SURCHARGE <br />_ <br />PUDLICV!ORKS <br />APPLICATION ACO BY PLANS APPR. DY <br />TOTAL <br />� <br />