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APPLIc" nON FOR CONSTRiC7ION <br />PERMIT <br />the Evergreen everett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAILADDRESS CITY ZIP PHONE _ n <br />ARCH ITE OR DESIE <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />GENEMLCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />�T�M.. I�n.]'s <br />J.�i SOQ i'r�- /✓E <br />I <br />/YY�yyl�'Ia.� WtA_ g821'S <br />nwVu DN IIOR LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE <br />00 <br />. • n I . � % ... _01.7 N.1_ c 7 ...L..rif 534d41 L <br />I, _ r"T .. ❑ wnnmQTnvaaool INRPRT ❑ 13LIlLDING RELOCATION <br />Lff NEW U ADDITION U ALTENATIVN u <br />ncrnm <br />CONTACT PERSON AND PHONE NO <br />TENANT IMPROVEMENT OR IHTERI011 REMODEL ONLY <br />Off• O <br />CONTRACT PRICE OF WORK: <br />DESCRIBE WORK ANO 9OUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />PROPOBED USEa BUILDING <br />KNOW THE SAME TO BETRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIEDHEREIN OR NOTTHEGRANTING OFAPERMIT DOES NOT <br />DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOURCOFIESI <br />LEGAL <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 />LOT BLOCK OF <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />AIS MADE <br />THIS PROPERTY PERFORMTO PPLICATION <br />AND ICOMNTHTHE S ATE CONTRACTORS LAW RCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PRQIECT ADDRESS(�,� <br />APPLIC T ITBUSINE LICENSENO.AND BUSINESS NAM <br />^ <br />MECHANICAL <br />PLUMBING <br />p <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C— A/HNDLG UNITS— M.P. <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS — ST.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK& DISP. <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRYTRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE& CHIMNEY <br />�.. <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />—� <br />HEAT PUMP <br />FCOR DRAIN <br />L <br />BACKFLOW PREVENTERS <br />OAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE — BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL <br />$ <br />PERMIT $ <br />PERMIT <br />$ <br />TOTAL FEE $ <br />TOTAL FEE <br />$ <br />SIDE SETBAC K <br />PLAN CHECK NUMBER F!! RECUR NO. <br />FRONT SETBACK REAR SETBACK <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION FEE <br />USEZONE ❑ YES ❑ NO <br />BUILDING <br />TYPE OF COMET. OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLDQ NO OF STORIES BSMT. <br />OY <br />OCG LOAD <br />MECHANICAL <br />DN <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />PUBLIC -WORKS <br />APPLICATION ACG BY PIANS APPA BY <br />TOTAL <br />