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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269-8810 <br />APPLICA' LION FOR CONSTRIo :TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE• <br />'EC<N Mf5v l 1hx—Nj5&)(6a69 LYPPwo&D 92'ogb 77(v 8P3S g&ZFN tWoaijzs <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTCH MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />aNEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVFI TENT OR IN ERIOR R(EMOOeE L�OONLY <br />CONTRACTPRICE OF WORK'*�3%O <br />CONTACT PERSON 'AND PHONE O/J ��YY ( � <br />»ry ( yL �/LJ WAI INC, 77: -MS- <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />S L S 1LL4.yrvM>y /MA-LL 3/6AI <br />PRoPOSED usE FBUILOINa 1. <br />&)'".azC Os- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <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 />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMITDOES 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 />FORMANCE OF CONSTRUCTION. THAT I 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 18.21 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X �� r s 3- $9 <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOI-_ BLOCK OF <br />PROJECT ADDRESS C� <br />OS is 52 i <br />_ <br />APPLIC SCITY BUSINESS LICENSE NOA BUSINESS NAME <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 />_ <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 />_ <br />CLOTHES WASHER <br />_ <br />_ <br />WOOD STOVE <br />_ <br />bRINAL <br />METAL FIREPLACE 6 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 />EXHAUST FAN <br />_ <br />SINK (SERVICE - BAR, ETC) <br />_ <br />SUB TOTAL S <br />SUB TOTAL $ <br />_ <br />PERMIT S <br />_ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />_ <br />_ <br />TOTAL FEE S <br />_ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONC <br />��1 <br />C ` <br />TOT AREA <br />VACANT SGE <br />0 YES U NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />vu <br />_ <br />'Ll'34t- <br />TYPE FCONST. <br />ALLOW <br />AILOWABLE/AC1UAl <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO.OFSTORIES <br />BSMT. <br />D Y <br />ON <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />