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APPLICAT.aN FOR CONSTRUGAON PERMIT <br />the Evergreen BVC'fC't( <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />❑ DEMOLITION Li COMBINATION I I BUILDING IXl MECHANICAL I I PLUMBING I I SIGN <br />OWNER MAIL ADDRESS CITY��/ ZIP PHONE <br />S,�/{/11r' 10E2��co <br />tNANV V MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADOR SS CITY / ZIP PHONE LICFNSFA <br />3E5,3 lig rt2tloarJ 91015 77Y-3//i- y�.{�Fd/� �306, <br />MECHANIC CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION LR REPAIR ❑ DEMOLITION 11 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRIDE OF WORK: <br />DE SCRIBE WORK AND SQUARE FOOTAGE I DIVED <br />r <br />CONTACT PERSON AND PHONE NO. <br />`->. 75/ <br />// +'--F—�Y�—^L• <br />[� <br />PROPO ED USE BUILDING <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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 PER!=ORM 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />/J"(�GI. % (�_ <br />APPLICANTS CITY BUSINESS LICENSE NO, AND BUSINESS NAK <br />LEGAL DESCRIPTICN OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <br />PROTECT ADDRESS //ll <br />r//o � S[ rw C✓ # f� <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/HNDLG UNITS-H II <br />; <br />BATHTUB <br />; <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 />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />—I— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />; <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />�- <br />SINK (SERVICE -BAR, ETC.) <br />; <br />I <br />; <br />I <br />, <br />I <br />I <br />, <br />_ <br />SUB TOTAL $ <br />SUB TOTAL $ <br />a. <br />PERMIT <br />$ <br />I <br />i- PERMIT $ <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 />USE ZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONSL ALLOWABLE <br />TYPE Of CONST. ACTUAL <br />OO(W W1 <br />GROUP <br />NO 9 DOUBLING UNITS <br />PLUMBING <br />SIZE OFBLDG. <br />NO. OF STORIES <br />BASEMENT <br />❑.YES 0NO <br />MECHANICAL <br />— — <br />�J"i-- <br />OTHER <br />OCCUPANCYLOAD FIRE SPRNKLERS REDD <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />HEIGHTLIMITATION <br />L <br />STATE BUILDING SURC14ARGE <br />STATE ENERGY SURCHARGE <br />�— <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCALS) <br />3105 TAX CODE IS <br />PUBLIC WORKS <br />TOTAL <br />