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APPLICATION FOR CONSTRUCTION lirwErAMIT <br />the Evergreen everelt <br />CITY Of- <br />everptt <br />BUILDING DEPARTMENT <br />259-8510 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION Ci COMBINATION ❑ BUILDING ❑ MECHANICAL LJ PLUMBING L 1 SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�F a�yc(Cs ti k)U i c F ytm st i�C�alsoa us bl ozg ; l <br />TENANT MAIL ADDRFlp CITY ZIP PHONE <br />It It It IL <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />$Q►J (I ._y6S u_ c{411 PICDAUD'Pb7o I,-R. m, QfS5 '),I 4l9%695' <br />GENERAL CONI FACTOR MAIL ADORE SS CITY ZIP PHONE LICENSE <br />Q1 531D <br />co n- �S boaSr sLd WI o� n,lu�um� <br />MECHANICA ONfRAO^TOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MN;', ADDRESS � CITY ZIP PHONE LICENSE <br />CLA55 OF WORK <br />C7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPA67 ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPNOVEMENT OR INTERIOR RR(�EEM'O'/tD-NEEL ONLY <br />CONTRACT PRICE OF WORK: AO yV�/ <br />CONTACT PERSON AND PHONE NO. <br />uu Wbbl 0 616--3100060 <br />_��/ �--c <br />OESCR DE WORKAND SQUARE I COAGE INVOLVED l(�, UI O L+4x� <br />11T �;'��r�N•�Rl� <br />PROPOSED USE OFBUILDINQ, <br />Ktt�u, SP,u-,-� <br />CL 1 '?S7 SiSl4- <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATES 1 <br />(' ��Sf ` :L <br />PLICANTS CITY B I SS LICENSE NO. ANT BW'Mt55 NAME <br />LEGAL DESCRIPTION OF PFUPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />---- — <br />PROJ/EQp1TfAU^CRE"5 I <br />I vv� 7t I <br />PLUMBING <br />_ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—S.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />T <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />_ <br />RANGE HOOD <br />I_ <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />; <br />_ <br />CI OTHES WASHER <br />—�— <br />WOOD - STOVE <br />URINAL <br />' <br />META'_ FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN _ <br />�— <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />_ <br />_ <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />FRONT SET04CK <br />REAR SETBACK <br />SIDE SETBACK <br />PLA CPC UMBER FEE / Q <br />I. <br />RECEIPT NO. <br />USEY-� <br />� <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />T— <br />TYPE OF CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OCGGPA <br />GRWP <br />NVVMULINGUMITS <br />PLUMBING <br />SIZE OF SLOG. <br />NO. OF STORIES <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS REOV <br />❑ YES ❑ NO <br />REASON FOR SPRINM_ERS <br />HEIGHT LIMITATION <br />I STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />—�— <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />