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lmor__t . (..,, <br />APPLIC�fION F0144 �or# <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />Y <br />ARCHITECT OR DESION:R MAIL ADDRESS. CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION TERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />.�u.u. ..eem•cucur no iummno PIAnr!FI ONLY CONTACT PERSON AND PHONE NO. <br />PRICE OF WORK <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 HEREINOR NOT. THE GRANTING OF A PERMITDOES 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 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 OFCONTAAC70R OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESS <br />( e <br />V,, to x.t �e i I I L p , T I <br />/ I / -6 '6 <br />.fin <br />APPLICANT CITY BUSMESSLICENSE NO.AND BUSINESS NAf�E <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS —H.P. <br />. <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS— B.T.0 (L/X M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_�_ <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />S <br />PERMIT <br />S <br />PERMIT <br />S <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLIVACTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF Si CRIES <br />BSMT. <br />❑ Y <br />ON <br />CC, LOAD <br />MECHANICAL <br />OTHER <br />-- <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATIONACG BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />_ <br />