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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER m nw .. <br />/_/l ,U, g 10:. 6 L, L 3 Yas �� 6,.K( fvT�eZf <br />____ ..... ........« CITY ZIP PHONE <br />y PLUMBINC CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSER <br />i <br />n _ t1 n ❑ INSERT ❑ BUILDING RELOCATION <br />LJ NEW <br />TENANT IMPROVEMENT O (INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />U •/'�/ <br />CANTRAGT PLACE OF WORK <br />_ 1 ll <br />rJl�� <br />DESCRISEWORKAND SQUARE FOOTAGE( OLV rU C <br />ki LL.c-a <br />�x(c� /Yf'JS.fed <br />PH POSED USE OF BUILDING <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 NOTTHE GRANTING OFA PERMIT DOES NOT <br />LEGAL DIE-5LRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR IEsI <br />/ A,V <br />Lot BLOCK GF <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />1 <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />TQt c( O I I <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />0 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APP CANT Y US 1 LICE S NO.ANOBUSINESS AME <br />^^ <br />PROJECT ADDRESS <br />3 Y� s— ti e H... 4, / ;F Y <br />q° <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILEn <br />-A/C— /VHNDLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />'� <br />UNIT HEATERS— B.T.U. M <br />_ <br />/ <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />VENTILATION FAN <br />/ <br />KITCHEN SINK d DISP. <br />'r <br />DISHWASHER <br />�^ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACEB CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />-- <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE — BAR, ETC.) <br />SUBTOTAF. <br />SUBTOTAL $ <br />^ <br />PERMIT <br />$ <br />PERMIT 5 <br />_ <br />TOTAL FEE <br />FRONT SETBACK / REAR $ETBAUCIS <br />$ ^ <br />SIDE SEfB9CK <br />TOTAL F _ <br />PLAN C�ECK t- �UMBERI FEE_ _ L <br />/) <br />CVALUATION <br />RELF.IIR NO.��� <br />�/�(�f���FEE <br />D] <br />USE ZONE ^ <br />K /` <br />LOTARZZEA <br />UDa SL ft <br />VACANT SITE <br />❑ YES O NO <br />FEEES, <br />BUILDIN�I 7Io <br />5 90 <br />J�/LAB <br />Yd< <br />OFDWELLING UNITS <br />OCCUPANCYCROUP <br />AILOVABLEIACTUAL <br />tit <br />3 <br />' <br />PLUMBING <br />SIZE OF BLCO NO. OF B�SMi. <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />/ <br />HE-,G/.TT L, IIT.AT NON <br />FIRE SPRINKLERS REQUIRED DYES KNO <br />vi�'�✓ <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />Al <br />. APPLICATIONC. BY PLANSAPP�0. BVL <br />TOTAL <br />I <br />I <br />I <br />I <br />