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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLIC�; FION FOR CONSTRU&ION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />Everett <br />e <br />OWNER <br />TENAN <br />MAIL ADO RESS <br />MAIL ADDRESS <br />Cliv <br />CITY <br />ZIP <br />ZIP <br />PHONE <br />PHONE <br />7GbL� <br />MCINIiECT ORp SIGNER <br />MAIL PDORE55 <br />Z <br />CIlY <br />ZIP <br />PHONE <br />GE-N7E�RAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />/�I iYJ of �/ / 4 /ah Jrf <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• /G'D <br />FIG,,✓ �Gli /,,0 / z 3o i3Y f SE Ey���rd- /✓�f 9f 2 G8 f/vL✓c'1�j�/d1 ro�i <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF VIORK <br />CONTACT PERSON AND PRONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMI NED 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 NOT. THE GRANTING OFA PERMIT DOES;'OT <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 PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />GWAG SIGNATURE <br />SIGNATUATU RE OF CONTRACTOR OR AUTHORIZED J'/A/GE/fNT/�� /PATE / <br />� 9� Q <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK of <br />PROJECT ADDRESSi�/�" <br />APPLICAJAS CITY BUSINESS LICENSE NO ANDIBUSINESS NAME <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 />MC— A/HNOLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— 6.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />L— <br />SHOWER <br />aF <br />_ <br />— <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />------------ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />WOOD STOVE <br />URINAL <br />S' <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACK.FLOW PREVENTERS <br />f� <br />FIREPLACE INSERT <br />HEAT?UMP <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK(SERVICE— BAR, ETC.) <br />_ <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />g <br />_ <br />_ <br />_ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI-N CHECK NUMBER <br />FEE <br />RECEIPTHO. <br />USE ZONE <br />LOT AREA <br />VACANT 517E <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONSL <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITSBUILDING <br />PLUMBING <br />�S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />USMT. <br />n Y <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES ❑ NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />