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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-BB10 <br />APPLIC.j nON FOR CONSTRU16TION <br />PERiowlIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />� c�fGlcSOAfNfFC EUTbyC SS1.2-,9ogm.5w /St'/AtWCCA13 9go36 7-7 3Sf9 ERfGK> 1f1L% <br />MEOHANICALCONTRAOTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSEF <br />CLASS OF WORK <br />rl NPw ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMFROVEMENT ORINTERIORREMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO, <br />DESCRIBE WORKAND SOUARE FOOTAGE INVOLVED <br />/ N 5 T tl-Lz Q p A F <br />PROPOSE& USE OF BUILDING <br />rr <br />I"00p 2 c—' .QE2G_ <br />C de <br />I HEREBY CERTIFY THAT I HPVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TA E AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING' HIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HERE114OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORI TY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUC-:CN. 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 10.27 RCW AND <br />296.2DO WAG <br />AAG`ENT DATE <br />SIGNATURE OORR AUTHORIZED AGENT <br />fO/F CONTRACTOR <br />APPLICA _S CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />I ,GAL DESCRIPPON CF PRDFEg1Y (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK_._ OF <br />PROJECT ADDRESS <br />/4(01 - 511_ ;UE2r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />110. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —NHNOLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KIrCHEN SINE: DISP. <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE 11001) <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE B CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PHEVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK(SERVICE— BAR. ETC.) <br />SUBTOTAL <br />S <br />S1:5 TOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />❑ YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLO'NABLE.'ACTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />— <br />_ <br />SIZE OF ULM <br />NO. OF STORIES <br />BSMT. <br />0 Y <br />❑N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />_ <br />FIRE SPRINKLERS REOUIRED 0 YES 0 NO <br />HEIGHT LIMITATION <br />I <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />