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I <br />IRS `.ve,gree0 <br />CITY OF <br />evereti <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLI�"`AI TION FOR CONSTRJCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />(TYNI;H mnil nJVnC t.ir• [�r _TT /�1Au CartF.,n,4s Isla s,E. �yjW�-r +au. cvAy Ey6>T <br />TENANT MAILADDRESS CITY :IP PIIONE <br />C t*4 A s 1-3 3.5 3— 4031 <br />ARCH:IEOTOR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />• MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW Ll ADDITION bd ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR RRrMOOD L NLY <br />^ANTRACT PRICE OF WORK IT L XAL <br />DO-N-TA PERSON ANDPRONENO <br />OESCRIB _5_ AND ARE OOTAGEIN�LVEO� <br />PR/O�PFOB'ED UrSE`TOFABUILD,I/N�O <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAME TO BE TRUEAND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED H EREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION ORTHE 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 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRA TOR OR AUTHORIZED AGENT DATE <br />-PCX ? 8.g5 <br />LEGAL DESCRIPTION OF PROPERTY ISHOY/N DELOW OR ATTACH DOUR CORE S) <br />LOT BLOCK. OF <br />-- <br />cyCIz- <br />PROJECTADDRESS <br />SLr-[ £IlFmr-r- XAit <br />Low-lrJ <br />APPL NIS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK8 DISP. <br />VENTILATION FAN <br />_ <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL 9 <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VAOANTSITE <br />DYES 0 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLCV/ABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />— <br />SIZE OF BLDO <br />NO. OF STORIES <br />I SSMT. <br />❑ v <br />oN <br />OCC. LOAD <br />MECHANICAL <br />OTHER <br />— <br />FIRE SPRINKLERS REQUIRED OYES 0N0 <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY FLANS APPR BY <br />_] <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />