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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICA�ION FOR CONSTRi;t T10N <br />PERMIT <br />Dverett <br />e <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />PHONE <br />ARCHITECT OR OESIONER MAIL ADDRESS CITY ZIP <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />m n n <br />INSERT ❑ BUILDING RELOCATION <br />EW t.J ADDITION U AuhHAIHJN u <br />CONTACT PERSON AND PHONE <br />NART IMPROVEMENT OR INTERIOR REMODEL ONLY <br />/NNO�y��//JJ�� <br />44 <br />CONTRACT PRICE OF WORK <br />O/ESCRISE WORK AND SOOUAARRE��FF`OO�OTTAAGE INVOLVVE-j/) ��y����y�7 <br />I H EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />PROPOSED USE DF BUILDING <br />_ <br />j �c.��, p6�.�G <br />[/�/ICGM iT� /! <br />AND <br />KNOWTHE SAME TOANCES GOVERNING ILL BEIONS OF COMPLE COMPLETED <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />NINGT AND CORRECT. OF <br />LEQALDESCRIPRONOF PROPERtt ISHOWNBELOW OP ATTACH FOUR COPIESI <br />WHEI HER SPECIFIED HEREIN OR NOT, THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />STATE OR LOCAL LAW N OR THE PER- <br />LOT BLOCK— of <br />ANYOTHER <br />FORMANCE OF CONSTRUCTION.REGULATING <br />THAT AMIAUTHORIZED BYOTHE OWNER OF <br />THIS PROPERTYTO PERFORMTHE WORK FOR WHICH APPLICATION <br />W 17CW <br />AND I WITHTHESTAT� CONTRACTORS ND <br />COMPLY <br />296.200 WAC. / <br />SIGNATUREO ONTRACIOR OR HORZED AGENT DATE <br />X �ll <br />�AJE�T Iowa <br />PROJECTAODRESS <br />AP I NIS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />f uJ,4- <br />PLUMSINQ <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/H NDLG UNITS — H.P. <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY(WAL; I BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER _ <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />, <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />13ACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />_ <br />_. PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL <br />FEE <br />S <br />FRONT SETBACK <br />REAR SETBACKIDCK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREAE <br />DYESNO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/ <br />TYPE OF CONST. <br />OCCUPANCY GROULLING <br />UNITS <br />— <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLCO. <br />NO.OF STORIES <br />MECHANICAL <br />OTHER <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED DYES O NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC BY PLANS APP BY <br />TOTAL <br />xn.mv....w,v.r v:. -;.T y . .. _., ... .. • r.� i tT �T:;:;;;rl <br />