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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIC,k(ION FOR CONSTR64;TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />%OWNER MAIL ADDRESS `CITY ( ZIP PHONE <br />"I EM%ENLO.I. �TN k1rT4 CUQR Ia-ac) `� <br />T_� <br />TENANT MAILADDRESS CITY _ <br />ZIP PHONE <br />1h�aTT ` iB 2 og Y/ 7 3S 3 - -1 <br />I S I "� S � Ev n�-F T LJ��IIar.L. E <br />11 <br />337 <br />'34 b <br />`/ 3 <br />:D N -(4-1I -Qs <br />WQ INJ Spy <br />CLASS OF WORK <br />11 M An Ttr .I M eI TCPennu I —I RFPAIR M nFMniiTION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINGRELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODD.fE�LONLY <br />G0 TrpCT PflICEOF WORK OO('] <br />CONTACT PERSON AND PHONE NO. <br />1 1 �J �r <br />TCNLACL �T T^1CN P,j �� `�� 11 DS1 1 <br />DESCRIBEWORKAN•OIS(O�UAREFOOTAGE INV//O��L1 D <br />RZ%%ktk)GT 4ViF?LACCr`CAJCCSSIOJSr.4A)b <br />PROPOSED USE OF BUILDIN, 3 <br />I•WU1 cr �rT�=1tT�V� <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHESAMETO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED H EREI N OR NOT. THE GRANTING OF PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 WAG <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X I ( rL IB9 <br />LEGALDESf,RI PTIONOFPROPERTYISMOWN BELOW OR ATTACH FOUR COPIES] <br />LOT__ BLOCK OF <br />PROJECT ADDRESS <br />q O-L- S Vj 1A <br />TS CI NSINESS 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 />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />SINK 8 DISP. <br />VENTILATION FAN <br />_KITCHEN <br />DISHWASHER <br />RANGE HOOD <br />— <br />_ <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />— <br />_ <br />SINK (SERVICE— BAR, ETC) <br />__ <br />__ _______----------- <br />------- <br />— <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />— <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />PEAR SETBACK <br />SIDE SETBACK <br />PLANCH <br />ClANC <br />iBEP <br />FEE 89 <br />C/�l lL� <br />RECEIPT" <br />[r�l t'11 <br />IK) <br />USE�E <br />I <br />LOTAREA <br />VACANTSITE <br />O YES PO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGROUP <br />_g <br />NO.OF OWELLINO UNITS <br />--- <br />PLUMBING <br />--- <br />SIZE OF BLDG. <br />T <br />NO. OF STORIES <br />SSMT. <br />❑Y <br />OCC LOAD <br />MECHANICAL <br />_ <br />OTHER <br />_ <br />FIRE SPRINKLERS REOUIREO A9YE5 ONO <br />HEIGHTLIMITATION <br />I <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY \\ <br />C....� <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />��)) <br />