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APPLIC,.(ION FOR CONSTR6%:TION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />eeverett <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER ( � -TrZ MAIL ADDRESS CITY ZIP PHONE <br />11 �l�%k��4�t�r ,ova SO, Sr -A, :9EA+-I 2a3 -ssg3 <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ RFPAIR 11 nFMnI ITInN n IAIn1f1 Tlll­­ ­11— n ...... ....._ __. __.__.. <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BDILDING <br />—_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG. <br />SIGNATUREOFCONTRACTOR OR AUTHORIZED AGENT DATE <br />X r ✓t r Imo/ p \mI1(� <br />�ENSE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LO7 BLOCK OF <br />PROJECT ADDRESS <br />zl <br />APPLICANTS CITY BUSINESS LI NO.ANOBUSIN�SNAME <br />PWMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />-;2­1 <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />7 IT <br />VENTILATION FANcl <br />DISHWASHER <br />RANGE HOODLAUNDRYTRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOODSTOVE <br />URINAL <br />fl <br />- METAL FIREPLACE & CHIMNEYDRINKING <br />FOUNTAIN <br />FIREPLACE INSERT12 <br />FLOOR DRAINHEAT <br />PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />DfL <br />SINK (SERVICE— BAR. ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />*3�,m <br />TOTAL FEE <br />$ <br />_ <br />TOTAL FEE $ <br />fn I <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMRER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />TYPE OF COAST. <br />ALLOWABLE/ACTUAL <br />LOT AREA <br />OGCUPANCYGROUP <br />VACANTSITE. <br />O YES O NO <br />NO. OF DWELLING UNITS <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF STORIES <br />BSMT. <br />D Y <br />N <br />OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATION ACO BY PLANSAPPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />