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a <br />ay <br />9 H Cn <br />HEX <br />mo <br />�Hv <br />xz <br />[s1 O�y <br />/H C'j <br />H A <br />zH <br />�H <br />HH <br />gCA <br />n C N <br />H rAA <br />H O Cn <br />APB P ICAT�IOI"FOR CONSTRUCTbA PERMIT <br />TO BE COMPLETED IN INK -PLEASE PRINT 11 1_t <br />the Evergreen A/ <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />8810 <br />F HEATING SYSTEM: ❑ GAS A ELECTRIC ❑ <br />everett <br />r, <br />259- <br />DEMOLITION <br />COMBINATION <br />X' BUILDING <br />MECHANICAL <br />-?PLUMBING SIGN <br />r 4 M /S ' <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ef <br />HrOWNERL. <br />TENANT • <br />MAIL ADDRESS <br />GIN <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />`3 <br />�a8 S3�/7�1 <br />✓ n <br />r <br />/we r /; <br />PHONE <br />LICENSER <br />GENERAL CONTRACTOR <br />AIL ADDRESS <br />CITY <br />ZIP <br />% .2,z 1A <br />S.vol%Q fl <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE It <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />R <br />___ _ i IunnneTnVFIFPPI NJ&FRT BUILDING RELOCATIOW <br />NEW X7 AUDII IUN ;_! ALItMA11UN <br />I-...1. <br />- <br />Sl/^ <br />2 <br />Qyh (//` <br />CONTACT PERSON AND PHONE NO <br />a <br />CONTRACT PRICE OF WORK `15 "' <br />DESCRIBEWORJK AND SQUARE FOOTAGE INVO�LLVVED_ <br />L ^ �4 S2 <br />S/v/l� /��/7/ /. bi✓ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />n - <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />p!/ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />(, <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 />/ <br />PROJECT ADDRESS <br />Z <br />APPLICANTS CITY BU ES ICE SE NO, AND BUSINESS NAME <br />n <br />Fer6 <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />O 1 <br />A/C-AIHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />3 LAVATORY (WASH BASIN) <br />/ SHOWER <br />5' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />ASHER <br />5 I - <br />WOOD STOVE <br />' <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />OUNTAIN <br />IN <br />M <br />HEAT PUMP <br />PREVENTERS <br />GAS PIPING <br />S-RAINLEADERS <br />EXHAUSTFAN <br />ICE -BAR, ETC.) <br />i <br />SUBTOTAL <br />$ <br />U - <br />SUBTOTAL <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />U ; <br />TOTAL FEE $ <br />- <br />n- -- ,u <br />FOR 0"JUL Ubr <br />FRONTSETBA K <br />U111LT: <br />REAR SETBAC <br />SIDE SETBACKI <br />PLAN LNEL N BR <br />G <br />�I� / u <br />RECEIP-?e <br />V <br />USEZONE� <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />ttPE Of LON75 ALlOWABIE <br />TYPE OF CONST ACTUAL <br />ampp Y 40 Of MILLING UNITS <br />PLUMBING <br />-� <br />- <br />Q"3 <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />65 Sf QD <br />2 <br />NQ <br />ADDITIONAL PLAN CHECK � <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REDO <br />HEIGHT LIMITATION <br />I.iO <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />5� <br />INTAKE BY <br />PUNS APPROVED BV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />>� <br />Nn n <br />L/ <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />Pi <br />