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APPLICATION FOR CONSTRUCTION <br />BBB <br />PERMIT <br />the EYergreen <br />CITY OF <br />Pve1P11 <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO E COMPLET DIN INK— PLEASE PRINT <br />kCLW414 ly�oo De re�� LakewwEi 58t•0777 <br />OWNER MAIL ADDRESS EIIY }II• PHONE c <br />_AJ.v_wr.�e C�necic;v. _ 41301s e1v,�_ rf_ bo4_T�om� 4ie� es <br />TENANT MAIL A iESS— - ----- -CITY ZIP PIIO E — �� �� <br />ARCHITECT On DESIGNER MAIL ADDRESS CIlY ZIP PHONE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBINOCONIDACTOP <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />orrNSE- <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION n WnnnclnVFren0I INRFGT 1 1 PITHnnmReclt,Avl k, <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRA.:T PRICE OF WORK .S <br />DESCRIBE\ORK AND SQUARE TOOMOSEINVOLV D <br />lu"4 ItQZv <br />PROPOSED USE OF BUILD( O <br />/ _ <br />0. l _Z!1_._ <br />Lift DESCRI *ON i M q�LDW OR AIIA.CII FouR coPl <br />tws TIA err �t fL/i C! J <br />LOT- BLOCK of <br />dI J <br />1� ^ <br />IputwBiy� �/.�C` �EiQ.�F1 <br />(P1) u�1ro►i! M't1'1 dl,cw S Lp_1w <br />CONTACT P RSON AND PHONE NO <br />-MJ_�•` <br />---- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWSAND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. IHEGRANTING OFAPERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHERSTATEORLO LLAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE ( CONS ,ON THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS AND PI RCOMPLYPERTY TOPt I E•S STATE CONTRACTORSTHE WORK FOR HLAWL18270N IS MADE <br />RCW AND <br />296.2DO WAC. may/ <br />SIGNATUREOfC AC ONn11N10RIZf0nGENi DATE 1i2i,7/ <br />PROJECT ADDRESS <br />"T �� A �� •#IS .t <br />,V V- <br />APPLICA Y l�S''NESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MEC.-�4 104L <br />Z <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. I 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 />_ <br />UNIT HEATERS-DT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />_KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_LAUNDRY TRAY <br />_ <br />_ <br />WATER HEATER ---- <br />--- <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS _ <br />GAS PIPING <br />_ <br />ROOF DRAINS - RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE - BAR. ETC) <br />_ <br />_ <br />SUBTOTAL E <br />SUBTOTAL E <br />PERMIT E <br />PERMIT E <br />TOTAL FEE E <br />TOTAL FEE E <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />PLAN�UCHT9K NUM <br />IBER <br />FEE iYO <br />RECEIPT <br />NO, <br />Ill <br />USEZONE <br />C_ 1 <br />TYPE OFCONST. <br />ALLOWABLEJACTUAL <br />. 'LN <br />LOTAREA <br />OCCUPANCYGROUP <br />Q <br />Ae/ -' Z. <br />VACANTSITE <br />D YES }Q NO <br />NO.OF DWELLING UNITS <br />B- <br />FEESVALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />11L <br />SIZE OF BLDG <br />NO. OF STORIES <br />WAIT. <br />❑Y <br />11N <br />OM LOAD <br />11 GV <br />J 1 <br />MECHANICAL <br />- <br />OTHER <br />HEIGHT LIMITATION <br />FIRE SPRINKLERS REQUIRED DYES NO IV14 <br />APPLt iIONA GBY PLANSAPPRB^ <br />/'"•/�T('//^ <br />STATESUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />-- <br />TOTAL <br />