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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICA`rJ74ON FOR CONSTRU I TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER <br />It <br />MAIL ADDRESS <br />CITY {� ZIP PHONE <br />TENANT <br />MAIL ADDRESS �- <br />/ CITY ZIP PHONE <br />L <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />4 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSE• 4 <br />MEC ANICAL CONTRACTOR <br />MAILADDRESS <br />CITY 21P PHLNE LICENSE/ <br />1 <br />C✓. Ua' zl' <br />�iC 31 !O F'%I <br />�� �U` : o�Si _ �3�/ or 4• I: <br />LUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSES <br />❑ NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENTOR INTERIOR REMODELONLY <br />CONTRACT PRICE OF WORK <br />CONTALTPERSON AND PHONE NO. <br />DESCRIBE WORN AND SQUARE FOOTAGE INVOLVED` <br />so' GAS plpP - �1.%a <br />PROPOSED USE OF BUILDING eY <br />rvo ('('cI cl, <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 />ORD INANCES COVER N I NG THI S TYPE OF WOR K WILL BE COM PLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER- <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 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />R SIGNAT WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 5 <br />X <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />— <br />PROJECT ADDRESS <br />E <br />APPUYANTS CITY BU NESS LICL SE NO. ANDBUSINESS NAI <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 />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGEHOOD <br />_ <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />_ <br />CLOTHESWASHER <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACEINSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SIPIK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />--_ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />❑ YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLEMCTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />_ <br />SREOFBLDO <br />NO. OF STORIES <br />SSMT. <br />O Y <br />ON <br />OCG LOAD <br />L:.CHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES ONO <br />HEIGHT LIMITATION <br />I <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLAN54PPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLI^•WORKS <br />TOTAL <br />9 <br />I <br />