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i <br />APPLICATILA FOR CONSTRUCI.ON PERMIT f <br />erett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />eve rett <br />HEATING SYSTEM: ❑ GAS <br />U ELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />259.8810 <br />1.1 DEMOLITION <br />I I COMBINATION <br />I I BUILDING <br />I I MECHANICAL L I PLUMBING I I SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />C�iarn,lLn� S <br />xNr Nso <br />k/�ks <br />ZnA BecLfgluH ?A <br />f90zo <br />TENANT <br />MAIL ADDREBB <br />CITY <br />ZIP <br />PHONE <br />a l ro 8ua Stares <br />�tSri <br />tv;„k <br />6eI,satem A6 <br />19Q1a1 <br />ARCHITECT OR DES( ER <br />MAIL ADDRESS <br />CITY <br />ZIPS <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />g82U <br />PHONE <br />ZN2-10 <br />LICENSE N <br />O Grrsc12/N <br />Puaef S�,tid Lok4me�ir� <br />.I-Ne. <br />1z9/f <br />F��✓e1A0.109 v <br />M�ECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />pfty <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />I rI U.lAl 1-1 AnnITInNI I I AITCRATInM I I RF AIR I I DEMOLITION I I WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />,( <br />•'ONTRACT PRICE OF WORK Q 6 <br />CONTACT PERSON AND P'/I^ONE NO. <br />were N r'�l �(1( e hlQ <br />DESCRIBE WORK AND SOUARE FCOTAGE INVOLVED <br />TetlawfS v0✓e L12 e at <br />PROPOSED USEOFDUILDI <br />2 r <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BEL OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PRCJE�T/fj[)1DRESS <br />_16. �Ve{� -ee% �Ia <br />qPP N CITY BUSIN SS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—AIHNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />i_ <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />I <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />I <br />_ <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />' <br />FIREPLACE INSERT <br />i <br />FLOOR. DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING _ <br />I <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR. ETC.) <br />I <br />' <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />, <br />PERMIT $ <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />P-nn nw,nO PICC nAll V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLA�� NU��3c <br />✓ <br />FEE /0�3� <br />RECEIPT NO. <br />USE OtIE <br />LSAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />5 <br />/L a ' vMr�` <br />V <br />I <br />i <br />— — <br />TYPE Of CONTS. ALLOWABLE <br />TYPE D�IST. ACTUAL <br />U _ Q <br />oCGPMNC <br />GROUP <br />NOOFIMULINO"IRS <br />�� <br />SIZE OF BLDG. <br />glom sF <br />NO. OF STORIES <br />I <br />BASEMENT <br />No <br />MECHANICAL <br />' <br />i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />2 1 Fj l%5 <br />REASON FOR SPRINKLERS F <br />OTHER <br />STATE BUILDING SURCHARGE <br />_ <br />_ x <br />INTAKE BY <br />PLANS APPR VED BY <br />CITY OF EVE RETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />IP 6 Q <br />166 <br />