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I -- <br />i f�1= <br />APPLICATIOA FOR CONSTRUMJN PERMIT <br />everett <br />TO SE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _ <br />BUILDING DEPARTMENT <br />259-8810 <br />J DEMOLITION [I COMBINATION ❑BUILDING ❑ MECHANICAL `�G` PLUMBING d❑�/S�IG(�N <br />OWNER MAIL ADDRESS _ _ _RY ` w I ZIPHE <br />A P, 0 f 1 Y 1 1 E F l) r 1.o QCP[LJC�) <br />CITY Z <br />NE <br />ARCHITECT OR DESIGNER MAIL ADDRESS ` '-M ij pCI�TY �l�I 21P �T�PH�D p c2oplvZ.'(•'j l(o0 <br />�.. ..__v ..n. �. •�II�A.I 0-i11 S f.Cn •TY Xqe 2E Jar+.• Ll�l� ` J' <br />CUSS OF WORK <br />[I NEW ❑ADDITION �yL.ALTERATION ❑ REPAIR ❑ DEMOLITION ElWOODSTOVEIFRPL INSERT El BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />. . \111Tc Co72-'I lto0 <br />CONTRACT PRICE OF WORK p wV T VV V <br />DESCRIBE WORK AND SQUARE FOOTAGEINVOLVED <br />255 2 <br />�Lc rT-•� <br />5, � YLACIYwt-ILCIAL. At-cLAI' LL 17%) <br />C <br />TI geACI VEF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OFOUfLDINO SPh� <br />F-.yvT,6 WIPcRT <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />h e-rA%L,— Cl-m <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY IS,O N BELOW OR ATTACH FOUR COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <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 18.27 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTRAC\fl OR AUTHORIZED AGENT DATE <br />c <br />PROJECTADDRESS <br />Ph� ylV_ <br />APPLICANT _BUSINESS LICENSE NO. AND BUSINESS NAME <br />Cl `PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />� <br />NO. EQUIPMENT <br />FEE <br />' <br />A/C—A/HNDLG UNTYPE ITS—H.P. <br />WATER CLOSET (TOILET) <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />' <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />' <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />I <br />RANGE HOOD <br />DISHWASHER <br />I <br />WATER HEATER <br />LAUNDRYTRAY <br />' <br />WOOD STOVE <br />CLOTHES WASHER <br />I <br />I <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />URINAL <br />i <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />' <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />ROOF DRAINS—RAINLEADERS <br />I <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />I <br />SUB TOTAL $ <br />'i <br />SUB TOTAL $ <br />' <br />PERMIT$ <br />PERMIT $ <br />_ <br />TOTA. cE $ <br />' <br />TOTAL F EE $ <br />' <br />FOR OFFICE USE <br />FRONT SETBACK <br />USE ZONE <br />c— <br />ONLY: <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CHECK NUMBER <br />FEES <br />VALUATION <br />flecEPT No. <br />FEE <br />jF5EE <br />BUILDING <br />ZOO .J O <br />I <br />TYPE OF COMS.ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OTLUMAtr <br />An.wONTllNcuxrts <br />PLUMBING <br />MECHANICAL <br />' <br />SIZELDG. <br />Z.SS 2 <br />N� STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRNKLERS READ HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />i <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERM <br />LOCALS <br />TAXXCODEDE IS IS 3105 <br />TOTAL <br />' �J <br />