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I� <br />OH <br />Cil Lzi <br />JAZ <br />tom" axa co <br />xyy+ gr3 <br />OHd <br />HM8 <br />> H t+1 <br />t 1--1 H <br />gca <br />H <br />Lq-] t7 EA <br />Ct1 � Cr+7 <br />zym <br />H O Tn <br />APPLICATION FOR CONSTRUCTION PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT 259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION >C, BUILDING MECHANICAL WPLUMBING <br />7.1 <br />❑ SIGN <br />OWNER <br />_? <br />MAIL ADDRESS <br />aL36 <br />CITY <br />Tr <br />ZIP <br />9S.>z014 <br />rn�nc <br />� sae 2— <br />_VI <br />TENANT <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />ai7cim Lm <br />s Ty i,n& <br />ALLLti SF\Mi <br />353-O.;ZRZ <br />ARCHITECT OR DESIGNER <br />��Y <br />MAR ADDRESS <br />CITY <br />75fh fuFaET <br />ZIP <br />`j3Zc)q <br />PHONE <br />353- 053 1 <br />� y,i <br />D�a1o4, dDlo <br />__..__.. �.............e <br />u.,, .nnocee <br />CITY <br />ZIP <br />PHONE LICENSE, <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE, <br />—' <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY ZIP <br />PHONE LICENSER <br />❑ NEW V AADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY— CONTACT PERSON AND PHONE NO, <br />CONTRACT PRICE OF WORK: n,2 1, 0 U <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />ADD-LY� <br />PROPOSED EOF BUILDING <br />I HEREBY CERTIFY T4AT I HAVE READ AND EXAMINED THIS <br />Q� S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�. QA _ LU2r) <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPER ISHOVMBELOWOR ATTACH FOUR CAPIESI <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL -'HE 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 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />�os2o <br />%C) <br />PROJECTADDRESS <br />(, <br />CANS CIUSINESS LICENSE NO. AND BUSINESS NAME <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/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—S.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />i <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEATPUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUSTFAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN NUMB <br />NOUSE <br />ZOreLOTAREA <br />VACANT SITE <br />FEES <br />FEE�71.— <br />*FEE'RECEIPT <br />cl <br />I <br />0 YES """0 <br />BING <br />�� ! 'L� <br />' <br />i <br />TYPE OF CONS(. ALLOWABLE <br />TYPE OF COW, ACIUAL <br />CmIDAMC! <br />IFRauP <br />Np. pf IAYFWNGIINIt, <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />7i <br />❑,YES NO <br />OTHER <br />' <br />I <br />OCCUPANCY LOAD FIRE SPRNKIERS REO'D HEIGHT LIMRATION <br />STATE BUILDING SURCHARGE <br />460 <br />❑ YES NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />I <br />APPLICATKXI ACC. Y <br />PIANBAPP OVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />3 ' <br />TAX CODE IS 3105 <br />TOTAL <br />DC oN-` 'i>-� FA2Wt1G- wT 6,&OS TKeu seoII, <br />