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APPLICis►`' ION FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />CITY Or everett <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />ONE <br />70rc- 'A /NC 5751,E �B Slyaq Cz�c vG�// K-ld-ity � v% � ) )_�, __I <br />ARCHITECT OR DESIGNER MAIL ADDRESS City PHONE <br />GENERAL CON TRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEr <br />LAE>t t WYCI=T AICTf]�/Dr,A inJS7�t(• 3SIU 19(� Sa s.���. e�-'c (/Jc P L� <br />PLUMBING CONTRACTOR MAIL AODPESS CITY ZIP .Y7 PHONE <br />CLASS OF WORK ��,,// .G9 /a IE:)S(n ta- ( I. ')'s <br />❑ NEW ❑ ADDITION I ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR R MODEL ONLY <br />CONTRACT PRICE OF WORK <br />CON,. ;T PERSON AND PHONE NO. <br />PEBCRI WLRKANDS_.UAR FOGTA INVOLVED <br />' <br />EO USE BUILDING c <br />���i�� <br />I HEREBY CERTIFY THAT I HAVE.:EAD 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. TH E GRANTI NG OFA PERMIT DOES 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 PROPERTYTO 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 NACTOn On AUTHO D ENT DATE <br />X ` �Xs <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT --BLOCK OF <br />-- <br />PROJECT Ap <br />�ADOI _ / <br />/J <br />APPLICANTS CITY BUSINESS( ENBEN .AND BU INE59 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. <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />— <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY_ <br />DRINKING FOUNTAIN <br />FIREPLACEINSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS— PAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL <br />$ <br />SUBTOTAL E <br />PERMIT <br />5 <br />PERMIT $ <br />Q C <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />0. <br />FRONT SETBACK <br />REARSEIBACK <br />SIDESETUACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />TYPE OF CONST. <br />LOT AREA <br />OCCUPANCYGROUP <br />VACANT SITE <br />DYES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />ALLOWABLE/ACTUAL <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZEOFBLOG. <br />NO.OFSTORIES <br />BSMP. <br />❑ Y <br />❑N <br />OCD LOAD <br />MECHANICA'_ <br />— <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />HEIGHTLIMITAVON <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANSAPPD. BY <br />— <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />9 <br />