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APPLICATION FOR CONSTRUCTION PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMEN F <br />259-0810 <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION <br />L1 COMBINATION 1 <br />I BUILDING LI MECHANICAL <br />L_I PLUMBING <br />OWNER <br />MAILADDRESS 1400,('� <br />CITY <br />ZIP <br />PIIONE <br />2i�Fi�3ulu rl�lg� tom- �IIVVI MAu <br />WAY <br />-0lS9T- JAW <br />(A6) <br />f5 -170(o <br />TENANT <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />_ s ►NG. <br />15� SrNA✓r/ <br />rTm <br />brat <br />ARCHITLC F OR DESIGNED <br />MAIL ADDRESS <br />CITY <br />ZIP <br />HON <br />GENERAL COW, PAT, OR <br />ICNLAADDDRE55 <br />CITY <br />ZIP <br />PHONE <br />LI:;ENSEI <br />'.t <br />MECHANICAL<ANTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE# <br />PLUM31WJCNTRACTOB <br />MAILAUDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />i <br />I i SIGN <br />❑ NEW ❑ ADDITION LKALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT U BUILDING RELOCATIOt' <br />7ENANT IMPROVEMENT EM//O�yyDE�L�L ONLY <br />CONTACT PERSON ANDPHO� JEEyNO <br />..NjR/I/O <br />77 <br />CONTRACT FRICEOF WORK: "( J)((W�w <br />ANT FOOTAGE INVOLVEDk <br />-- 1SOUARE <br />))DEESC��RIBIIE//W��ORK <br />PROPOSED UGE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Pr-loY :9 ~ UdiMi At P <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 OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK of _ <br />_ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />1 <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 10.27 RCW AND 296.200 WAC. <br />SIGNATURES OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />-�r�tylS�• <br />PROJ[CT AGGRESS <br />G <br />ArLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />T (PE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C-A/HNDLG UNIiS-H.P, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />T— <br />_ <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />TRAY <br />; <br />WATER HEATER <br />_LAUNDRY <br />CLOTHES WASHER <br />I <br />WOOD STOVE. <br />; <br />URINAL <br />I <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />—�-- <br />DA.CKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />' <br />i <br />I <br />_ SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />�— <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />WN CHECK NL' 0 R r <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />PIES <br />VALUATION <br />FEE <br />❑ YES L7 NO <br />BUILDING <br />"]S1�o)C�' <br />�y-u�u— <br />T— <br />, <br />TYPE Of CONBT. ALLOWABLE <br />_ <br />TYPE OF CON51. ACTUAL <br />IXNPANCY <br />Na or oxnuxouuns <br />_ IV <br />(f ao�IP <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />� <br />2155 SR,r. . <br />! <br />❑ YES ' 0 <br />OTHER <br />OCCUPANCY LOAD FAI�R(E SPRINKLERS RED D HEIGHT LIMITATION <br />iD it YES ❑ NO <br />STATE BUILDING SURCHARGE <br />La i <br />REASON FOR SPRINKLERS <br />LT_ JC� <br />STATE ENERGY SURCHARGE <br />_ <br />APPLICATION ACC. BY <br />�%� <br />PLANS APPROVED BY <br />CITY OF EVERETT 1 <br />LOCAL SALES <br />PUBLIC WORKS <br />i <br />✓r/ <br />TAX CODE IS 3105 <br />TOTAL <br />3 G <br />