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APPLICATIGA <br />FAR CONSTRUCT.JN <br />PERMIT u <br />TO BE <br />COMPLETED IN INK —PLEASE <br />PRINT <br />The EVergreon <br />CITY OF <br />everett <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259- 10 <br />fODEMOLITION <br />COMBINATION <br />BUILDING <br />MECHANICAL <br />J PLUMBING SIGN <br />MAILAOURESS <br />CITY <br />ZIP PHONE <br />LtiC <br />�i.2//� LrFi/6�F��Y <br />4iay Fi7 Y£�,aoy <br />t Sj '77q <br />TENANT <br />MAIL ADDRESS <br />CITY <br />21P PHONE <br />NoAf <br />_ <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITYZIP <br />PHONE <br />N/Q <br />GENERAL CONTRACTOR <br />IAAM1 ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />DGNLF1 <br />2n i <br />�/.2/D F/oaGa�s� <br />/-� ?iJ ?.r4-7Fa <br />Q U�le�/�YML <br />/�C' <br />7 <br />MECHANICALCONTGACTOR <br />� <br />MA!LADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />PLUMBING CONT��CTOR <br />MAIL ADDRESS <br />CITY <br />21P PHONE <br />LICENSE <br />CLASS OF WORK � <br />- n Anr.mnAl --! AITPRATInM F RFPAIR iiiDEMOLITION Li WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTACT PERSON AND PHONE N0. <br />CONTRACT PRICE OF WORK <br />U - <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLV,,E1V- <br />CY S/ u Tv4 �. Cr- 2 Ltd <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOT! THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AT i@ ORDINANCES GOVERNING THIS TYPE OF <br />OR FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY)SHOWN BELOW ATTACH <br />WORK WILL BE COMPLE';ED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />Soo ��pc�l� <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGN EOF CONTRACTOR OR AUTHORIZED AGENT GATE <br />PROJECT ADDRESS�� <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />97�7 F-✓< <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOH DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I — <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OttuPNx[r <br />HO dINAwKUNIIS <br />GRNP <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRINKLERS RECO HEIGHTLIMITATION <br />I <br />OTHER <br />I <br />REASON FOR SPRINKLERS <br />- <br />�/- <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSAPPROVED BY <br />CITY OF EVERETT <br />PUBLIC WOT'MS <br />' <br />--T <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />