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�PPLIChr ION FOR CONSTRIA TION <br />PERMIT <br />the Evergreen everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�DyANC� C><1P1/U(i <br />3Ds fE E1lERft <br />14416 IA14`f Sti,g l9 <br />97s=.49- <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />LILY ZIP PHONE <br />GENERAL CONTRACTOR (n�/nTr <br />I[,q ICJ <br />M/AILL ADDRESS 1�/) �D�/1 <br />-MAILADDRE55 C1 1 / ;L�'V <br />/�%C/ITIY1�'�(1 �ZZIP p PHONE <br />I /�/1/� <br />/iY�T'ICITY✓�V '�� AV.P Ci d4) 4NNr �16M <br />Mi ,( I Sf4/JD <br />. <br />EN <br />DNTRAf.TC <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />1 - <br />u 11 . ..T.n. rl AITRRATInN n RFPAIR I71 DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENT61IMTERIORREMODEL ONLY `-C <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />NUILDING EL <br />5 <br />PROPoseo USE OF B <br />}j,e.ri1 �L <br />1 HEREBY CERTIFY Th AT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREINOR NOT. THE GRANTING OFA PERMIT DOES NOT <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 />CONS: RUCTION. THAT I AM AUTHORIZED LITHE OWNER OF <br />FORMANCE PROPERTY <br />THIS PROPERTY TO PERFC'IM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />GWAG SIGNATURE <br />SIGNATUATU RE OF CONTRACTORCH AUTHORIZED AGENT DATE <br />X M I cle <br />LEGAL O`ES1C/FR'YIiPf10N OF PROPERTY ISIIOWN BELOW OR ATTACH FOUR COPIES) <br />LO7 BLOCK OF <br />PROJECTADDRESS <br />3p5 % I/E MACG w <br />1 / `fie10 <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINE55 NAME PLn <br />340 7 r'V4'—LI OVE''Tp <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- ST.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -:TT U M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK d 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 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR. ETC) <br />SUB TOTAL <br />$ <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE / <br />G <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCLUPANE,V GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />DSMT, <br />Ely <br />❑ N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED 0YES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APP BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />5 <br />