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_ e-, <br />APPLICAT mON FOR CONSTRUL iION PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259.8810 <br />LJ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICA <br />TENANT MAIL <br />W65F'IE.DS 36:L . Ls <br />ZIP PHONE <br />CITY ZIF <br />Zc1 <br />❑ PLUMBING 11 SIGN <br />GENERAL CONTRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE If <br />MECHANIFAL CONTRACTOR , MAIL ADDRESS <br />CITY <br />({EDACLWD <br />21P <br />gBoST— <br />PHONE <br />$83 92Z¢ <br />LIC€NSEtl <br />�lt7ZrT�t2i63c� <br />ME¢.LrIL.I.EeM-wle.t*- 963 o—ISj�4VeNc <br />PLUMBING CONTRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEI <br />CLAss ur..P" v_/ '^ r— n ...A.0 n nPMnl ITInN F- WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />u New a ruin I PUN I " . 111�...... <br />._...... — - - <br />TENANT IMPROVEMENT ORINTERRIIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />p /I <br />CONTRACT PRICE OF WORK: 4-10 sr..-b•t� <br />' <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />EVISEl <br />Rm LOVE rF IZMFPL4C C Lw <br />!r Ducrtnk <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I 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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OH ATTACH FOUR COPIES) <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LO7 <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 I 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 .2�¢ 7 AND 296.200 WAD. <br />U <br />SIGNATUR FCONTRA OR gIIT` ORIZEEDD AGENT O TE <br />— <br />X <br />1`13`39 .I�lET2�r M¢e1,...lres/t <br />PROJECT ADDRESS <br />#1 <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUBINEBS NAME <br />7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C-AIHNDLGUNITS-H.P. STG.-I <br />FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PRE.VENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />' <br />I <br />I <br />SUBTOTAL <br />$ <br />' <br />SUBTOTAL $ <br />1 ' <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $' <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />uSEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />❑ YES 11 NO <br />ttPE OF LOHSL ALLOWABLE <br />TYPE OFCONST. ACTUAL <br />eCCU"" <br />4P°0v <br />xo. ov lAHUlxc urns <br />PLUMBING <br />SIZE OF SLOG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />CQ/ <br />YES ❑ NO <br />OTHER <br />' <br />OCCUPANCY LOAD FIRE SPRN✓.LERS RED <br />HEIGHT LIMITATION <br />❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />1 ' <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC, By <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLICWORKS <br />LOCAL SALES <br />t( <br />TAX CODE IS 3105 <br />TOTAL <br />