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H <br />aHf~A <br />HEX <br />�I (7 <br />H x1 <br />toH <br />xx y H <br />tA7 O ri <br />1-4 <br />^. V <br />9 HI <br />t' Z <br />H H3 <br />grA <br />H <br />0 0 11Vc11L..ayy <br />O N <br />c ! <br />A" <br />APPL.ICAfION <br />FOR CONSTRL%OATION <br />PERMIT <br />the Evergreen <br />ovrn•tl <br />CITY OF <br />everett <br />BUILDING DEPAFITMENT <br />259.8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNEq <br />MAIL ADDRESS LIiY LIV <br />E'/biQFsTT 9gZO/ <br />PHONE <br />252-9s3s <br />Ja/lN CL�/80/ty� <br />3.V& `,tyWtcAVIE <br />TENANT <br />MAIL ADDRESS <br />Sh'rr <br />CITY 21P <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAILADDRESB <br />CITYDP <br />PHONE <br />Qdw NC2 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PONE LICENSE <br />awyil'R <br />MECHANICAL C04 WACTOR <br />MAILAODRESS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />I-, _ ra n Fl e n On.., O nM I -I wnnnSTDVF/FRPL INSERT Cl BUILDING RELOCATION <br />TENANT IMPROJEMF.Ni OR INTERIOR f• EMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CpNTPI.T PERSON AN[D P/H2ONE NO <br />L`ESLRIBE WORK AND SOUARf. FOOTAGE VOLyyED <br />`;; Z Qf oJ' OZL L��� <br />PROPOSED USE OF BUILDING <br />RC i 491*4,C <br />4 <br />__ <br />I HE REBY 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 SPE.CIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE O= CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO 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 />SIGNATUREOF <br />CONTRACTOR OR AUTHORIZED AGENT DATE ! V��/�-�Z Y✓U <br />LCGAL DESCRIPTION 01 PROPERTY ISNOtVN BELOW OR ATTACH FOUR COPIE^ul <br />�' 7$/Z � <br />J zcj tiJ/ �T� O/4r N <br />LOr BLMK OF L <br />PROJECT ADDRESS <br />F /W OL 112illf <br />pp,B AN BGITYBUSINCBS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />'HATER CLOSET (TOILET) <br />A/C — AJHNDLG UNITS — H.P. <br />/ <br />BATHTUB <br />FORCED AIR SYSTEMS— b.-,.U. M EA <br />Z <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BT.U. Id <br />SHOWER <br />/ <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />I <br />CLOTHESWASHER <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />/ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE— BAR. ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAP SETBACK <br />SIDESETBAGK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />DYES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFOONST, <br />ALLOWABLEJACTVAL <br />CCOUFANCY GROUP <br />NO OF DWELLING UNITS <br />-- <br />PLUMBING <br />SIZEOFBLDG <br />No Of STORIES <br />MYT. <br />DN <br />OCC LOAD <br />MECHANICAL <br />— <br />OTHER <br />FIRE SPRINKLERS REOUIRED ❑YES DNO <br />HEIGHTLIMITATION <br />_ <br />STATE BUILDING SURCHARGE <br />APPL'CAiIONACC BY FLANB APPP. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />is <br />OTAL <br />1� <br />r <br />