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APPLICATiON FO.. <br />The Evergreen . <br />CITY OF CONSTRUCTION <br />everett <br />everett PERMIT <br />e <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING XWECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER - MAIL ADDRESS CITY ZIP <br />Mike, LeboL Q. <br />PHONE <br />� bRs <br />343. <br />oa -S <br />ARCHITECT OR DESIGNER MAIL DSS CITY PHONE <br />Glan1J� pSX-' Z <br />Avi. <br />ZrSZ,-Z15'5 <br />GENERAL CON ACTOR <br />w tu�A�, 5 i 466t <br />MAIL ADDRESS CRY ZIP <br />- <br />PHONE <br />LICENSE <br />MEGIANIf.ALCONTRACTOR MAIL ADDRESS CITY ZIP <br />(V•Ul. rvUW2Cz`� S�ISTi S Z�al�i 52 A iL vJ (.kIlJIQlA)UIj <br />PHONE <br />NOV <br />LICE14SF. <br />7i ESLSZNZ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY TZIP <br />PHONE <br />LICENSE <br />1-14-Zy8o <br />CL SS OF WORM. <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING <br />RELOCATION <br />F .�W��OA,.COST OF MATERIALS PLUS LABOR) <br />VALUATIOVNK OF <br />a <br />- 1- n <br />DESCRIB W Rn <br />T�s ll E.xbw�L F*4%. (WiniltuL rLklAAk+- <br />'`aU <br />USE OF BUILDING <br />A �i1..�,0 SA,L�+S W�M� p••" , <br />�L� <br />I HEREBY CERTIFY THA I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPLIFLNTSCTTYBUSI ESSLILENS IO <br />LEGAL OESCRIPTION OF PROPERTY ISH OWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK OF <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T. U.M.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 />LAUNDRY TRAY <br />I 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 — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />$ <br />TOTALFEE 5 <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />I PONT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />- <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />APPR FOR ISSUANCE BV <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESYUNSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />