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the Evergreen <br />CITY QF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPL.ICAON <br />FOR CONSTR6i'TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNER MAIL AODI1E5 CITY ZIP PHONE <br />wy tv1ee- 3,1/7- 3975 <br />lY ZIP PHONE <br />GENERAL <br />CONTRACTOR <br />` MAIL ADDRESS ` ./ CITY ZIP PHONE <br />ZY Z[p LVV OA IICENSE <br />FO U ,Js <br />u 0 98oyt, 771 �Xd 3S REHtAV ril <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />LICENSE It <br />❑ NEW yv ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOV-FR ❑ <br />TENANT IMPROVEMENT OR ILyN,TERIOR�R ONLY <br />PL INSERT BUILDING RELOCATION <br />^� <br />CONTRACT PRICE OF WORK* I'pV <br />CONTACT PERSON AND PHONE NOEMODEL <br />�o <br />D�ESC�RIByE WORK AMU SQUARE FOOTAGE INVOLVED <br />Cn(WERI� 7/L� <br />����1 �C�I�r 00� <br />0A 7V 6 <br />1 FOSED <br />( I <br />G foill Ji,6N <br />9E OF BUIL01 0 <br />�M <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />M �� /� <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />LEGLL DESCRIPTION OF PgOPER1Y (SHOWN BELOW OR ATTACH FOUR COPIEG) <br />WHETHER SPECIFIED HEREIN OR NOT. THEGRANTING OFAPERMITDOESNOT <br />LOT BLOCK OF <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG. <br />CONTRAC70P Oil AUTHORIZED AGENT DATE <br />'IGNATUREA I� <br />X <br />8—/9-89 <br />PROJECT ADDRESS <br />2.1 5f 19V&20V_ /lA&LL <br />W Y <br />APPLICANiSCITYBUSINESSLICENSE NO BUSINESSNAME <br />$Eatzv <br />Nfb N C 52 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />— <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS —RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE— BAR, ETC.) <br />SUBTOTAL- <br />$ <br />SUBTOTAL g <br />PERMIT <br />S <br />PERMIT <br />__ <br />TOTAL FEE <br />FRONTSETBACK REARSETBACK <br />$ <br />SIDE SETBACK <br />TOTAL <br />PUN CHECK NUMBER <br />FEE <br />FEE <br />RECEIPT NO. <br />US —ZONE IOTMEA <br />C' — <br />NCANTSItE <br />0 YES U NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLE/ACTUAL <br />OOCUPANCYGROUP <br />NOOFDWELLINGUNIiS <br />PLUMBING <br />_ <br />SIZE OF BLDG. <br />NO. OF STORIES BSMT <br />OCC LOAD <br />O Y <br />MECHANICAL <br />_ <br />❑ rl <br />uE101TUAUTAi1ON <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPL'CAt10N ACC BY PLANS APPR Y <br />PUBLIC WORKS <br />IJ <br />/ <br />TOTAL <br />J <br />