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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLIC. TION FOR CONSTMvuFTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />11 <br />OWNER MAIL ADDRESS CITY ZIFF PHONE <br />SE EQt_ EK � (AGSM r-UrR G�22aL 3ti'1 c�50 <br />ENANT MAILADDRESS CITY ZIP PHONE l \ <br />it <br />ARCH <br />AILADDRESS CITY <br />\\11DESIGNER <br />\Ic\�r�.KNJM(�ILilk 0as\A90\!J\ &N3, ZIP PHONE <br />'CC-�ohN <br />MEGHANIGAL GUN I KA :I Vn mm cao .... _.. ..._.._ <br />(l\ChSO,T'1��.1uF \UQ�C& 55 2"Z 2oX L\-IN Q - q�bo�1 -lsc 1 <br />P UMBINGCONTRAOTOP MAIL ADDRESS CITY ZIP 'HONE LICENSE <br />?� C_\O\Z130.43 <br />NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINC RELOCATION <br />NT IMPROVEMENT OR INTERIOR REMODEL ONL <br />CONTRACT PRICE OF WORK G <br />Ff <br />^/- HQ cloa <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />i,�uj LQ& S -4 si9?�u�A <br />Cv�utx t0 OQi3� <br />PROPOSEDUS OFBUILDING1 <br />�f IA ,., ,, .,L...t — <br />hi 4- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOTTHEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF CONST UCTION. THA I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO P ORMTHE RK FOR'WHICH APPLICATION IS MADE. <br />AND I COMP W THE STAT CONTRACTORS LAW 18.27 RCW AND <br />296.200 YVAC. / <br />SIGNAi FrEOF ONT CTORORAIM 2EDAGENT DATE <br />t G IV <br />APPLI ANTSCITYBUSINESS LICENSER ND BUSINESS NAME <br />LEGAL DESCRIPTIONUFPnOPERNISHO N BELOWOH Al IACHF COPIES) <br />LOT— BLOCK OF <br />PROJEICTADDRESS <br />Z_ W/^^ <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 - ArHNDLG UNITS -H.P. <br />BATHTUB <br />FORCED AIP SYSTEMS- B.T.U. M EA <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS- B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNURYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT _ <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR, ETC) <br />- <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />USEZONE <br />_ _ <br />REARSETBACK <br />LOT AREA <br />SIDE SETBACK <br />V%CANTS)T�F <br />0 YES NO <br />PLAN CHECK NUMBER <br />ZES <br />FEE <br />VALUATIaON <br />RECEIPF NO. <br />7FEE <br />BUILDING <br />In Lic` o <br />�� <br />TYPEOF LEJACT <br />ALLOWABLE/AfiUWZ � <br />••[ZG <br />OCCUPANCY GROUP <br />! - � <br />ND.OF DWELLING UNITS <br />.�. <br />PLUMBING <br />J - <br />SIZE OF BLOC. <br />elo <br />NO. OF`STTOORIES <br />I BSMT. <br />YN <br />OCC LOAD � <br />.' <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS RECURRED DYES oND <br />HEIGHT LIMITATION <br />Al,* <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANSAPPR BY <br />/�y"� l <br />1i(" � <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />,rc <br />