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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICATION FOR CONSTRli.1TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />ARC TE O?R DES�NER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLAS9 OF WORK/ ,�y <br />'j El NEW pl ADDITION X ALTERATION Ity REPAIR ❑ DEMOLITION KWOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CANT EE SOINA D�PHONE yNO�. <br />/ <br />U- <br />DESCRISWRKAND SOLIARE FOrGE INVOLVED <br />OF <br />PROPOS RUSE OFe ILDINa <br />(HEREBY CERTIFY THAT (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.THEGRANTING OFA PERMITDOES 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 OF 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 />SIGNATURE OOOFFFCC/COONNTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTIO44 FPgOPER (SHOWN BEL RATTAC FOUR COPIE I <br />LOT BLOGK�/ pF./ <br />f <br />PROJECT ADDRESS <br />APPLICANTS CITY USINESS LICENSE NO AND BUSIN EB TAME z <br />PLUMBING <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. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —B.TU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <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 />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL & <br />SUBTOTAL & <br />T PERMIT & <br />` <br />PERMIT $ <br />TOTAL FEE & <br />TOTAL FEE & <br />FRNiTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />PECEIPT NO. <br />USEZONE <br />LOTAREA ,,( <br />e�o l/1 <br />(CU t/rG !lUP <br />VACANT SI <br />0 YES A NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />C <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYpROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />F <br />312 O LDG. <br />8aC.1 <br />JaB <br />NO OF BTORIES <br />/ <br />BSMT. <br />❑ Y <br />N N <br />OCC LOAD <br />MECHANICAL <br />R <br />OTHER <br />i <br />FIRE SPRINKLERS REOUIRED ❑ YES NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />Li <br />/ <br />APPLICATION ACC BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />It? <br />TOTAL <br />