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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICA%CION FOR CONSTR :TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />V <br />HANICAL CON MC TOR MAILADDRFSS CITY ZIP PHONE LICENSE <br />PLUMBINOCONUR TOR MAIL ADDRESS CITY JP PHONE LICENSE <br />CLASNEW <br />OF NORK yin <br />❑ NEW ❑ ADDITION .0 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY , <br />K '^ CONTRACT PRICE OFWOR-of, <br />CONTACT PERSON AND PHONENO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />_ <br />ED USE OF BUILDING <br />• L Q <br />'� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /><NOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLE-.ED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT JOES 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 1 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 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />L RI OF PRO R 1 HOWN BEL OR ATTACH O C PIESI <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />�QS S.� E✓ r <br />PLUMBING <br />APAMARrstim B S 55 ENSE NO. BUSINESS NAME <br />_ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <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 />UNITHEAIERS—RT.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLAr:E & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACEINSERI <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />' SINK (SERVICE —BAR ETC,) <br />_ <br />SUBTOTAL <br />& <br />SUBTOTAL & <br />PERMIT <br />S <br />PERMIT & <br />TOTAL FEE <br />& <br />TOTAL FEE & <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK. <br />PLAN CHECK UMBER <br />ao�s3 <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />❑ YES {YNO <br />FEES <br />VALUATION <br />-EE <br />BUILDING <br />P <br />J <br />TYPE OF CONST. <br />ALLOWABIFJACTUa[iI� / <br />(Y/ <br />OCCUF. NCYGROUP <br />Q --a, <br />('/ � <br />NO. OF DWELLING UNITB <br />PLUMBING <br />SRE OF K=NO <br />OF STORIES <br />SSMT, <br />a Y <br />OCC LOAD <br />7 <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED YES NO <br />HEIGHTUMITAT!ON <br />STATE BUILDING SURCHARGE <br />Scj <br />APPLICATION ACT. BY PLANS APPR. BY^ <br />;/ <br />w <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />