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I <br />APPLIC, ►i'ION FOR CONSTRL�TION <br />PERMIT <br />the Evorgrenn DYcretl <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAILADDRESS CITY ZIP PHONE <br />DRESS CITY ZIP PHONE LICENSE I <br />GENERALCONTRACTORrRAc Ati*w IhIC_ ('p.AD3OX 5'2619 LyvNwooD 10VI6 7*24-M5- �IZRM Nd(25°7� <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />;4 m fl r l m M n=Unl ITInN n WnnOSTOVPIFRPL INSERT ❑ BUILDING RELOCATION <br />TEHANTIMPROVEMENTORIN RRIIOjnn REMODEL ONLY <br />J7 I CONTRACT PRICE OF WORK?? <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />77.5 tcuutN to i <br />PROPoseD 9EOF BUILDING <br />Conn M (PLC I <br />LEOALDESCRIPTIONDF PROPERIYISHO,LN BELOW OR ATIAGH FOUR COPIE51 <br />LOi BLOCK of <br />IHEREB', 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 />WHETHERSPECIFIED HEREIN OR NOLTHEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF rASTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROP'•'.: r TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I t.UMPLY WITH THE STATE CONTRACTORS LAW 10.27 RCW A6ID <br />296.200 WAC <br />SIGNAIUP OF ONTRACTOROR AI IORIZEDAGENT DATE <br />x 3 - 9 <br />PRO.IECTAODRESS <br />'7Go� 6VejZC-R65v VY 5W/71- (f <br />PLUMBING <br />APPLICA CITY BUSINESS LICENSE NO. IDBUSINESS 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— A/HNDLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL <br />5 <br />SUB TCTAL S <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL FEE 5 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />0 YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CANST. <br />ALLOWABLEIACTUAL <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF PLDO <br />NO.OF STORIES <br />BSMT. <br />O y <br />0 N <br />OCO LOAD <br />MECHANICAL <br />— <br />OTHER <br />TIRE SPRINKLERS REQUIRED OYES ONO <br />HEIUHTLIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />