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APPLICATION FOR CONSTRUCTii,.lIV PERMIT everett <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett Vi <br />HEATING SYSTEM: ❑ GAS 8 ELECTRIC ❑ —� <br />BUILDING DEPARTMENT <br />259-8810 <br />u DEMOLITION COMBINATION BUILDING X MECHANICAL - PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TENANT / MAIL ADDRESS CITY ?)P PHONE <br />den Q/Zw j4 /90aYE �o-z c7i�/� lei /y Evereh, wl ' ping -58/-3oSS _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CI :1P PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHAN)CAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS f.ITY 21P PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION '2S ALTERATION ❑ REPAIR ^ OFMn1 ITIr1M -1 wnnnemvEiEooi ,. n ,. <br />/� <br />T PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK �POOC7, oo <br />�CON-T[AF <br />^mil / �// <br />�i'/�7[!A C/4/IC✓ �JE/(p—to QL/— <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />/ <br />7n5/// � I- w LzZ/i Ac ee 1W4 ol7 <br />PROPOSED USE OF BUI'.r IIG Ate_ <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 DESCRIPTION OF PROPERTY (SHOWN BELOW ORATTACH FOUR COP(ES) <br />Lor BLOCK of <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />— — <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM Au rHORIZED BY THE <br />— <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 296200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X &==. <br />PROJECT ADDRESS <br />APPLIC�A TS CI B INESS LICEN E .AND BUSINEgS NAME-- <br />Q <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 />A/C—A/HNOLG UNITS—H.P. <br />_ <br />; <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN). <br />I _ <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />' <br />— <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />; <br />URINAL <br />; <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />I FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />; <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />7 <br />PERMIT $ <br />PERMIT $ <br />; <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOH OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDINr <br />' <br />TYPE DFCONTS. ALLOWABLE <br />TYPE OF CONS7 ACTUAL <br />OCCUPANCY <br />NO OF OMLLING UNITG <br />PLUMBING <br />_ <br />i <br />GROUP <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />�— <br />MECHANIC/L <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />ADDITIONAL. PLAN CHECK <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />i <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />TAX CODE IS 3105 <br />