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APPI_ICATIvN FOR CONSTRUC`i ION PERMIT <br />i <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 <br />I DEMOLITION COMBINATION BUILDING _MECHANICf.L PLUMBING SIGN <br />OWtIER <br />MAIL ADDRESS CITY :IP PHONE <br />TE NT MAIL ADDRESS ONE <br />CITY P E I <br />�I <br />ARCHITECT OR DESIGNER MAILAODRESS � : ZIP PHONE <br />( o : �n ��,�,(-� I��I Iq 57 s 0—� (i% o?o <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHON 8G ICENSEa O/IE <br />MECHANICAL CQN�ACTOR MAIL AC CITY II' PHONE LICENSE <br />PLUMBING ONTR TO) IAI RES Y ZIP PHONE LICENSEa <br />CLASS OF WORic IAlnnrgT(1VF1FRPl INSFRT I I BUILDING RELOCATION <br />U NEW LJ AIUUI I IUN MLI �11 1L ,. ..�. ..... _. _.___.. <br />_. <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLYCo <br />CONTACT PERSON AND PHONE NO <br />-' J <br />CONTRACT PRICE OF NORK- J J J <br />WDESRI WORN AN :11 1ARE FCOTAXINVOL:'EJ <br />I•+E uaD.NG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />C/ . <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />_ .,�� 02 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WGRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEG AL DESCRIPTION OF PROP EllTVIC9H_c!Y!IN UELOWW ATTACH FOUR COPI ES) <br />OF <br />NOT. THE GRANTING OF A PERM;T DOES NOT PRESUME TO GIVE <br />LOT_ BLOCK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />S G %e feJ L'/ BT 5 <<' BLS -/+- n u1 A% kLp <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU IORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />el Dd1T 4� <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/ �� Q'A� IJ T�/5���-/ •,—. 1 , <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />— <br />QV <br />PROJECT ADDRESS <br />go a <br />APPLICANTS tITY BUSINESS LICENSE NO, ANU BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXT URE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />- <br />FORCED AIR SYSTEMS-B.T.U. <br />BATHTUB <br />i <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />_- <br />—_T- <br />' <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK & DISp <br />VENTILATION FAN <br />DISHWASHER <br />�— <br />RANGE HOOD <br />1 <br />LAUNDRYTRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER�— <br />WOOD STOVE <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />i <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />' <br />' <br />GAS PIPING <br />T— <br />ROOF DRAINS-RAINLEADERS <br />T_ <br />_ <br />EXHAUST FAN <br />' <br />, <br />SINK (SERVICE -BAR, ETC.) <br />-� <br />SUB TOTAL $ <br />_SUB TOTAL $ <br />--�— <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CI�N;MBER FEE CCU <br />�t/ ✓ <br />RED yy0��� <br />BUJ <br />f ST 7 <br />USEzO <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />.� <br />I I YES I O <br />BUILDING <br />PLUMBING <br />s.is' <br />ri SoZ ' O 6 <br />TYPE OF CONST. ALL OWABLE <br />TYPE OF COII T. ACTUAL <br />OCCDPANLY <br />nouP <br />xO or DWUlrveunns <br />SIZE OF OLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />3u7 S� <br />II <br />YES ii NO <br />OTHER <br />; <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />I <br />I)t) RYES NO <br />STATE BUILDING SURCHARGE <br />'` <br />7 �D <br />i <br />STATE ENERGY SURCHARGE <br />' <br />i <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY <br />PLANS APPRQVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />IS 3105 <br />TOTAL <br />S6 fd <br />TAX CODE <br />