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i0 P L I C A T I O N F O h=- <br />the Evergreen <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION <br />Ulf33UILDING ❑ MECHANICAL <br />OWNER -., <br />MAIL ADDRESS , I f CITY — ZIP <br />�,53 55 %ItAA <br />C ��` evereN eJJ �dH� <br />� 01�- Irt.A�l Ci <br />❑ PLUMBING <br />❑ SIGN <br />CHrtEGT OR OESIG ER ((�� MA., ADDRESS 1�{ G1YQ / ZIP H/pNE ,/ L� /� <br />11 1� S'�2L— So:_ RIESS �+JCY2L/1/21��.AI 487 �O� <br />GENERAL CONTRACTOR MAIL ADDRESS Gry ZIP PI ONE—Z LICENSE <br />(-')n1 d P_r <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION BALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT Cl BUILDING RELOCATION <br />VALUATI OF WOPKICOST Of MATERIA LUS LABOR) �1�� <br />�� <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE) RUE ANDCORRECT. ALL <br />PROVISIONSOF LA.WSAND ORDINANCES G'JVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />INORNOT, THE GRANTING OF A PERMIT DOES NOT PRESUME'10 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PROJECTADDRESS <br />aq-z 1 2faA S—. <br />APPLICANTS CITY BUSINESS LICENSE NO <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 />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.U./H.P <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS — B T,U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNORY TRAY <br />UNIT HEATERS — B.T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CK NUMBER <br />�� Z c 3 �� <br />FEE <br />)os <br />RECEIPT NO. <br />USE E <br />t <br />LOT AREA <br />VACANT SITL <br />OYES O <br />FEES <br />VALUATION <br />FEE <br />BUILD IU5.30-7G.tU �3 <br />b r0 - <br />/5 <br />p <br />9 <br />TYPE OF CTO7N^S'T. I' <br />OCCUPAANNNCCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />/_W - <br />CJv J l' <br />NO OF STORIES <br />MAK. OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED XYES O NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />2 <br />50 <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />� <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />' <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />