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APPLICATION FOI <br />TM Evergreen <br />of <br />CONSTRUCTIONCITY <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING O MECHANICAL <br />OWNLR <br />CITY <br />❑ PLUMBING <br />Premium Shop __305SE Evaratt Mall Wa, Everett 98208 <br />AIICHITECI OR DESIGNLR MAIL AUDR CITY ZIP PHONE <br />17 eFtn <br />U <br />❑ SIGN <br />GENERAL CONTRACT: R MAIL ADDRESS CRY nP PHONE LICENSE A <br />United Western P.O. Box 33428 Seattle 98]33 367-3801 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL <br />Robinson P1 <br />CITY ZIP <br />LICENSE F <br />CLASS OF WORN - <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOD,Tp':C/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATIOA OF WORKICOST 01 MATERIALS PLUS LABOR, — <br />$380.00 1 <br />Plumbing addition <br />USE OF BUILDING <br />retail <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSANO ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PPf.,VISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULA1 ING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACIGR OR AUTHORIZED AGENT DATE <br />X — A -00 <br />LEGAL DESWI PITON OF PROPERTYTSHOWN BELOWOR AI7AC1I FOUR COPIES, <br />LOT— BLOCI�_ OF <br />-- <br />PROJECT ADDRESS <br />305 SE Everett Mall Way, Unit 23 (Bldg. A) <br />APPLICANTS 7 BUSINESS LICENSE NO <br />MECH: ' - . AL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A•C — A/HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B T.0 /H P <br />SHOWER <br />GAS FIRED A C. UNITS — B T.U. <br />KITCHEN SINK A DISP. <br />FORCEU AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS —B. T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T U. M <br />CLOTHES WASHER <br />EVAPORATII :..COLEF S <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />1 <br />FLOOR DRAIN <br />5 <br />00 <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS—RAINLEADERS <br />WOCD STOVE <br />1 <br />SINK ISERVICE — BAR, ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EAHAUSTFAN <br />SUB TOTAL <br />f <br />Q <br />oo <br />SUBTOTAL <br />PERMIT <br />$ <br />10 <br />00 <br />PERMIT <br />TOTAL FEE <br />S <br />20 <br />00 <br />TOTAL <br />PLAN CHECK NUMBER <br />FEE <br />FEE <br />RECEIPTNO. <br />FEE <br />TRONT SETBACK <br />nEARSEIBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />\ACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />BUILDING <br />PI UMBING <br />- —' <br />MECHANICAL <br />OTHER <br />S <br />TYPE OF CONS, <br />OCCUPANCY GROUP <br />NO Of DWELLINGUNITS <br />SIZE OF BLDG <br />140 OF STORIES <br />NAK OCC LOAD <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE c .ERGY SURCHARGE <br />APPLICATION ALC BY <br />FLANS CHECKED BY <br />AI`PR FOR ISSUANCE. BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />