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APPLICATh*,N FOR CONSTRUGIII .ON PERMIT <br />the Evergreen everett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />1-1 DEMOLITION Ll COMBINATION I BUILDING [eMECHANICAL I�LUMBING i I SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />I}r��H�. A,,N (yILsS IL°I L~ clln" <br />r4lA2f- <br />ARCHITECTORDESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE N <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />U(p /o6yolUE2eA k`L/ QLt <br />CITY <br />rwe 9910Oj1 <br />ZIP <br />PHONE <br />2-06 M16s: <br />LICENSE <br />0 le /33E7( <br />PL,UM��TBINnG CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />r( /q Cam.% <br />L♦ lF <br />CLAS F WORK <br />I NEW ❑ ADDITION Ll ALTERATION I I REPAIR <br />I I DEMOLITION <br />L I WOODSTOVE/FRPL INSERT <br />LI BUILDING RELOCATION <br />TENANT IMPROVEMENT ORINTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK .3 OS <br />F <br />U15D <br />AND PHONE NO. <br />COPTTACT gab M, <br />(} OA ,1/Gr <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVE <br />PROPOSED USE OF BUILDING <br />1\ �+o G i oss' <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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE 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 16.27 RCW AND 296.200 WAC. y <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE /2-ZB-3t' <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDflE55 I' <br />I i1 o' VCeS t IVI CL 1 / 4 C_ <br />Y1 ', I l (�I <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —A HNDLG UNITS—H.P. <br />I <br />-- — <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />/ <br />LAVATORY (WASH BASIN) <br />, <br />/ <br />UNIT HEATERS—B.T.U. M Z04013N <br />T <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />; <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRYTRAY <br />/ <br />WATER HEATER A51L -t14c <br />CLOTHES WASHER <br />—�7a <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />�— <br />HEAT PUMP_ <br />T— <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />— ' <br />ROOF DRAINS—RAINLEADERS <br />�— <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />, <br />I <br />SUB TOTAL <br />$ <br />' PG <br />SUB TOTAL $ <br />PERMIT <br />$ <br />, <br />PERMIT $ <br />TOTAL FEE <br />$ <br />:coTOTAL <br />FEE $ <br />14 ; GPi <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />I. I YES L I NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING � <br />Ild <br />I Jo <br />TYPE OF CONST ALLOWABLE <br />TYPE OF CONST.ACTUAL <br />OCLUFAxCY <br />GflOxP <br />xa OF O'NFu,NGuxns <br />SIZE OF BLDG. <br />_ <br />AO. OF SI JRIES <br />BASEMENT <br />11 YES ❑ NO <br />MECHANICAL <br />�[r <br />7Ji <br />OTHER <br />OCCUPANCY LOAD::j FIRE SPRNKLERS flEO'0 <br />tJ YES I I NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />' <br />STATE ENERGY SURCHARGE <br />�— <br />APPLICATIONACC.BV <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31?5 <br />PUBLIC WORKS <br />TOTAL <br />0 <br />