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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />ARCHITECT OR DESIGNER <br />APPLICATION FOR CONSTI,JCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />mo <br />PLUMING CONTRACTOR MAIL AUOFESS CITY ZIP PHONE LI�S.�� <br />❑ NEW ❑ ADDITION v TERATION ❑ REPAIP ❑ LEMOLITION ❑ WOODSTOVE/FRPLINSERT I] BUILDINGRFLOCATION <br />TENANT IMPROVEMENT ON IN' t RIORRE/M�ODEL ONLY� CONTACT PEA SON AND PHONE NO <br />1 CONTRACT PRICE OF MONK 44 <br />; �X A� I. 1 V <br />I. <br />DESCRIBE WJRK ANO OUA EFOOTAGE INVOLVED <br />_ <br />PROPO ED WE OF BVIl01 <br />\' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIOII AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW:', AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETEDWITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOEE NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT ION OR 1'HF 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 WAO <br />SIGNATURE OF CONI FACTOR ORAU711ORIZED AGENT DATE <br />✓ l✓ I <br />CIiY BU51 SS LICENREN A BUSINESS NAME <br />AL DESCnIPTION OF PROPER LEGTY(SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLDCK__ or <br />_— <br />PROJECT ADONESS\^��//10 <br />/��N_PCICANiS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OH 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 />LAVATORY GNASH BASIN _ <br />FORCED AIR SYSTEMS —BT.U.� !EA <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK DISP. <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />STOVE <br />URINAL <br />_WOOD <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />_ <br />INSERT <br />FLOOR DRAIN <br />_FIREPLACE <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />EXHAUST FAN <br />_ <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />SUR TOTAL $ <br />SUBTOTAL $_ <br />ZILE_ <br />PERMIT $ <br />PERMIT <br />70TAL FEE $ <br />1 <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIOESETOACK <br />PLAN CHECKNUMSER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />TOT AREA <br />SITE <br />YES <br />0YES ONO <br />FEES <br />VALUATION <br />F=E <br />BUILDING <br />TYPEOFCONST <br />ALLOWABLE/ACTUAL <br />OCC.IPANCYGROUP <br />NO.OFDWELLING UNITS <br />PLUMBING <br />SIZEOFBLDG <br />NO?FSTORIES <br />BSMF <br />O Y <br />DN <br />WCLOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES D No <br />HEIGNTLIMITATION <br />OTHER <br />_ <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPF. LY� <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />IT <br />