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APPLICATIO.. FOR CONSTRUCT6jNf PERMIT <br />the Evergreen TO BE COMPLETED IN INK -PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />HEATING SYSTEM: ❑ GAS 51 ELECTRIC 0 <br />everett <br />e <br />I I DEMOLITION <br />I I COMBINATION <br />I I BUILDING <br />I I MECHANICAL I I PLJMBING I I SIGN <br />OWNER <br />MAIL ADDRESS 'JUU CITY <br />ZIP <br />PHONE <br />CAt-r-ApElDcy, 3Eo`-5- <br />132niPAUB`,�c <br />p.)ELj_efuc <br />q,8006.13'L3 <br />643•-A3or., <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE ' <br />ARCHITECT OR DESIGNER <br />"PYi'l✓MAILRVcH <br />MAIL ADDRESS <br />I162.OFil, f <br />CITY <br />GVEke.Tr <br />ZIP <br />`j¢Zo► <br />PHONE <br />3�,`i -1397 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS Sal TE �1It OCITY <br />0Lbe•_-.,.-.- <br />ZIP <br />nu.-:� <br />PHONE LICENSER <br />��;1-14-/ L> `r die CdL IIRL9 <br />MECHANIC CONTRACTOR MAIL AUUHGob ""• -" <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE ' <br />1-1 RPPAIR f 1 nFMOLITiON CI WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />1� <br />CONTACT PERSON II <br />IE P <br />CONTRACT PRICE OF WORK / cvc J <br />1-3 <br />BESCHIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Q.Yf)Lr30* O I%'rn:MjkMj- I1(n��v r N e7v T <br />643 -43 o T <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�� I c, S f; L.Ar. cl, <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />e,-rA <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />FOUR COPIES( <br />LEGAL DESCRIPTION OF PROPERTY(IIOWN BELOW OR ATTACH <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK OF <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 2961200 WAC. /��f/�%O <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT Q/DATE <br />PROJF.CTADDRESSp <br />770G h-- Y VF��K V v ' `/ L <br />1— K V �+ �V <br />APPLICANTS CITY BUSINESS 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—A/HNDLG UNITS—H.P. <br />' <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 />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN _ <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />1 <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />I <br />� <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $ <br />' <br />TOTAL FEE $ <br />' <br />T Vn vrrly L• v.a� <br />FRONTSETBACK <br />USEZONE <br />r <br />v.�.-.. <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT� ,SITE <br />v� <br />PLAN CHEC NUMBER FEE <br />FEES <br />�.� <br />VALUATION <br />RECEIPT NO. <br />FEE/'/ <br />BUILDING <br />PLUMBING PLUMBING <br />n <br />`(i 'VI <br />TYPE OF CONTS. ALLOWABLE <br />TYPEDF CONST. ACTUAL <br />'TiROUT.— <br />�( <br />OCCUPANCY <br />NO 6 MLI ING UNITS <br />MECHANICAL <br />I <br />SIZE OF�{LDG. <br />GXI G• <br />NO.OF ST—DRIES <br />OASEMENTQ <br />� <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS IT <br />✓�S <br />' <br />1/EIGHT LIMITATION <br />OTHER <br />' <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />^' <br />YVL <br />PLANS APPROVED By <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3185 <br />PUBLIC WORKS <br />TOTAL <br />�LJ <br />I <br />