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APP! iCATItid FOR CONSTRIJ-'TION PERMIT <br />the Evergreen everett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />I EC1 tC,(rS 1 uc 1 cAPN- \�U Ste_ 4�P�uy Q- 11s b� O2q 20I �� I - II Oc7 <br />TENANT MAIL ADDREfS CITY ZIP PHONE <br />ll Il LL SL 1 ' <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />-mg C.. Rvl;c�au" RII PIeD Ru foo L-, R. ca. g(35 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />t&s 'g- ca' -)S b nsr SLR SAxdnth( Y11t hgSbq 016 530 COW <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />I 1 NEW 1 ADDITION I ' ALTERATION n REPAIR ❑ DEMOLITION I -I WOODSTOVE/FRPL INSERT 1-1 BUILDING RELOCATION <br />TENw IT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />rONTRACTPRICEOFWORK: C'OIWO <br />CONTACT PERSON AND PHONE NO. <br />f-uk) I w'al l-d 616--s30006o <br />DESCRIBE WORK AND SQUARE FOO AGE ItalED <br />1 m Lrr <br />d 7S SAS 4- <br />PROPOSED USE OF BUILDING <br />S [%Lxis <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 />WCRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. l'HE 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 DATE <br />DAATEE <br />PLICANTS CITY D It SS LICENSE NO .4NG BU., SS NAME <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJ TAOD ES <br />_I G. <br />-1 <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 />T— <br />BATHTUB <br />_ <br />FC RCED AIR SYSTEMS-B.T.U. M_E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />_ <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE 1-1007 <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />_ <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />_ <br />EXHAUST FAN <br />�— <br />SINK (SERVICE -BAR, ETC.) <br />r <br />_ <br />T <br />I <br />1 <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />' <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />; <br />FRONT SE TBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLA C CUER <br />t✓ <br />FEE /^6 <br />RECEIP`T NO. <br />USE ZONE <br />..- I <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUAITII'OON <br />FEE <br />BUILDINGGR[U <br />TYPE OF CONST. ALLOWAOI E <br />TYPE OF CONST. ACTUAL <br />_ <br />IIL my <br />-A <br />NO a UWEILINC, UNITS <br />PLUMBING <br />SIZE OF BLDG, <br />1,0 sp 'r <br />NO. OF STORIES <br />BASEMENT <br />LI YES NO <br />MECIIANICAL <br />1 <br />OTHER <br />OCCUPANCYLOAD FIRE SPRNKLERS REO'D <br />XYES 1-1 NO <br />REASON FOR SPRINKLERS <br />HEIGHTLIMITATION <br />A:.A' <br />STATE BUILDING SURCHARGE <br />�m <br />STATE ENERGY SURCHARG'e <br />-1'— <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />OF EVERETT <br />CAL SALES <br />CODE !S3105 <br />PUBLIC WORKS <br />� <br />TOTAL <br />- <br />