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APPLICATIvN FOR CONSTRUC b A'ON PERMIT <br />the Evergreen evefe« <br />CITY OF e <br />everett <br />BUILDING DEPARTMENT <br />259-8810 7'O BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION LI BUILDING ❑ MECHANICAL ❑ PLUMBING 11 EIGN <br />OVME AIL ADDRESS �)n Cltt ZIP PHONE <br />TENANT UES,a� Spa/ 10 h NE <br />TENA MAIL ADORES CITY ZIP PHONE <br />u <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 31P PHONE <br />GENERALCONIRACTOR <br />/A ADDRESS <br />e�/, <br />�ryTy ZIP PHONE <br />,/iO/i,, , <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />I <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PRONE <br />LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION IJ REPAIR 1_.I DEMOLITION I] W0r7DSTnVF/FPPI INICGPT I -I oI III nv.a o0 <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK: <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVE <br />x e/y <br />oUSEOFDO [NO <br />X <br />.�2( <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRI TION OF OPERTY (SI IO N BELOW OR ATTACH FOUR COPIP.S) <br />LOT <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 1 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 />AUTHORIZED AGENT DATE <br />SIGNATUREX�OF CONTRACTOR OR I, -e-91 <br />)/i <br />� ng��jg� ��Z... <br />PROJECT ADDRESS <br />APPLICANTS CITYBUSINES 1C NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />I TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />_ <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />+ <br />DISHWASHER <br />RANGE r HOOD <br />' <br />LAUNDRYTRAY <br />+ <br />WC?EFl HEATER <br />I <br />CLOTHES WASHER <br />WOOD STOVE, <br />_ <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />+ <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />+ <br />EXHAUST FAN <br />r_ <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />I <br />1 <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />+ <br />PERMIT <br />$ <br />—`— <br />PERMIT $ <br />_T <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUA1pER <br />PEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />13UILDING - <br />�— <br />' <br />TYPE OFCONST.ALLOWARr <br />TYPE OF CONSi. ACTUAL <br />otil .1-1 <br />NO aONTIIMG UNITS <br />PLUMBING <br />i <br />GRW <br />SIZE OF BIDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL— <br />�- <br />❑ YES ❑ NO <br />OCCUPANCY LOAD FIRE SPRINKLERS RED <br />HEIGHT LIMITATION <br />OTHER <br />i <br />U YES ❑ NO <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />, <br />STATE ENERGY SURCHARGE <br />—T <br />+ <br />APPLICATION ACC. <br />APPROVED BY <br />CITY OF EJERETT <br />PUBLIC WORKS <br />' <br />7YPLAN5 <br />LOCAL SALES <br />TOTAL <br />—_� <br />(00 <br />TAX CODE IS 3105 <br />I, <br />