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I <br />f ... <br />C7' <br />C+] t~tl 'f] <br />C�H <br />Y''ii1l <br />APPLICATIO►. <br />FOR CONSTRUCTI.dN <br />PERMIT <br />me Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITYOF <br />everett <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />Li DEMOLITION COMBINATION <br />BUILDING MECHANICAL <br />_i PLUMBING <br />SIGN <br />OWNER MAIL ADDRESS <br />n PIS W C2 E. I'{�sF_1..rY� <br />Cltt ZIP PHONE <br />#ZCb '9T FAl,, I D f3'a854 <br />i?1�E � 113 351n1 <br />TENANT MAIL ADDRESS <br />iy{zID6 a• `t l SBLTICa <br />CITY ZIP PHONE <br />�ZL17 �St �A1ls ID f33B5R <br />(2p$0113.351D1 <br />ARCHI IECT OR DESIGNER MAIL ADDRESS <br />M 60o CITY ZIP PHONE <br />CONTRACTOR <br />MAI ADDRESS IM0 <br />CITY <br />ZIP PHONE <br />LICENSER <br />&;;ZGENERAL <br />E. 2p <br />�EMOrFI_ F rtAYE <br />ME �rrtF <br />981b2324 3b21 <br />CgEA-17 z105y--6 <br />MECHANICAL CONTRACTOR <br />taAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />CUSS OF WORK <br />: 1 NEW �, ADDITION <br />.: ALTERATION ! REPAIR <br />❑ DEMOLITION <br />C1 WOODSTOVE/FRPL INSERT <br />L7 BUILDING RELOCATION <br />CONTRACT PRICE OEM <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE VOLVED <br />PROPOSED USE OF 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 PERFORM 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 />IGNATUURRREEEOFFFCONTT```R/RAAC�CTTTOR��RO}}yR///A//AUTTHORIZED AGENT <br />//� DATE 9/J�/ <br />LL.6D-l)../� <br />S&LeANTS <br />LEGALDESCRI TI NOF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />IOT BLOCK OF <br />— - <br />PRWECTADDRESS <br />y <br />CITY SLICENSE O. ND BUSINESS NAME <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.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHESWASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE B CHIMNEY <br />; <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR, ETC.) <br />' <br />SUBTOTAL $ <br />; <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />9jzcfA/ <br />FEE <br />I Ss <br />RECEIPT NO. <br />41S 2f— <br />USEZONE <br />LOTAREA <br />VACMITSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Q 6,m <br />89 i D D <br />� <br />TYPE Of CONTS. ALLOWABLE <br />_M 5 <br />TYPE Of LDNST ACTUAL <br />occuwAY <br />G�°•Z <br />I NO GrGWLUlxcuxlTN <br />512E OF BLOC. I& <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />ADDITIONAL PLAN CHECK <br />1 <br />OCCUPANCY LOAD FIRE BPRNK ERB REDD HEIGHTUMITATION <br />C <br />REASON FOR SPRINKLERS <br />OTHER <br />` <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />C <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />n <br />