11102 EVERGREEN WAY 2018-01-01 MF Import

APPLICATIOM FOR CONSTRU�TIuN PERMIT the Evergreen everett CIiV OF � everett BUILDING DEPARTMENT 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT � DEMOLITION ❑ COMBINATION ❑ BUILDING CI MECHANICAL ❑ PWMBING ❑ SIGN OWNER M AOUPESS CITV ZIP PHONE �F�(Q�'4��v� i�'cjn�t'�'e� 3�0o i�� ay Lynnul� u.I� 4�i3� ENA�T/� MAILADORES CITV ZIP PMONE �� ARCNITECTOflDES'GNER MAILADDRESS CITV ZIP PHONE GENEP4LCONTRACTOR MAILADDRESS CITV ZIP PHUAE LICENSE� M�'1�;hP.��%i �XC'.CxJ0.�-�' �c, �cJ3c�''I-�� h `P1 l.J �,�v�n�.cJc'�c�i �4R7�D3� h'1�T�.HEyt-�oicR MECHANiCALCONTRACTOR MAILADORESS CITV ZIP PHONE LICENSE/ PLIIMBINGCIXJTMCTOR MAILADDRESS CITV ZIP PHONE UCENSE/ � CUSSOFWORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR �C'�DEMOLITION Ci WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION TENANT IMPROVEMEMOfl INTERIOR REMODEL ONLY CO TACT PERSON AND PHONE NO. i CONTiUCTPRICEOFWORN: U` �I �/1 ` ,n�l� _f _1 DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED C 4 G-' PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS DQ�md ' APPLICA?ION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL LEGALDESCNIPTIONOFPROPERTV�SHOWN6ELOWOqATTACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF ��t B�aK oF WOFK WILL BE COMPLETED WiTH WHETHER SpECIFIED HEREIN OR – – NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOC;1L LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIO� IS MADE AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND 296.200 WAC. SIGNATUREOFCONTRACiORORAUTHOPIZED ENT OATE �'J'CTAODRE� Ory �i L��re.� ��`/ • �"` J APPLICANTSLITVBUSINESSLICENSENO.ANUBUSINESSNAME PLUMBING MECHANICAL NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EDUIPMENT FEE WATER CLOSET(TOILET) � A/C–q/HNDLG UNITS–H.P. , AATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � LAVATQRY(WASH BASIN) __ � UNIT HEATERS--B.T.U. M ; SHOWER � CLOTHES DRVERS � KITCHEN SINK&DISP ; VENTILATION FAN � DISHWASHER � RANGE HOOD LAUNDRYTRAY ; WATER HEATER � CLOTHES WASHER � WOOD STOVE ' URINAL ' METAL FIREPLACE 8 CHIMNEY � DRINKING FOUNTAIN � FIREPLACE INSERT � FLOOR DRAIN � HEAT PUMP —r- BACKFLOW PflEVENTERS � GAS PIPING � ROOF DRAINS–RAINLEADERS � EXHAUST FAN , SINK(SERVICE–BAR,ETC.) � , � � i 1 i � SUB TOTAL $ ; SUB TOTAL $ � PERMIT $ � PERMIT $ ; TOTAL FEE S ' TOTAL FEE $ � FAONTSETBACK REARSETBACN SIDESETBRCK PLpNCHECKNUMBER FEE RECEIPTNO. 115EZONE LOTAREA VACANTSITE FEES VALUATION FEE ❑ YES ❑ NO BUILDING ' ttPEOFCONSiALIOWABLE 7YPCOFCONSi.ACiUAL Cc[UPAucr NO.OfDwElliN6uNii5 � � GNO�P PLUMBING i SIZCOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL � ❑ YES ❑ NO � � OCCUPANCYLOAD FIflESPRNKLERSREO'D HEIGHTLIMIiNTION OTHER � ❑ YES Cl NO STATE BUILDING SURCHARGE i RE.>SON FOR SPRINY.LERS i STATEENERGYSURCHARGE � APPLICRTION ACC.BY PLANS APPROVED BV CITY OF EVEflETT PUBLIC WORKS i LOCALSALES ' TAX CODE IS 3105 TOTAL ;