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N <br />the Evergroen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIF PHONE <br />L1� rs � SLR K�_2 12 4 1.�eoyr_EV_gr r 4f320l Z5'7-16 <br />iFNANi MAILAOR ES> S CITY ZIP PHONE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CI'Y ZIP PHONE LICENSE <br />❑ NEW ❑ AUDITION ❑ ALTERATION L7 REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR. REMODEL ONLY <br />CONTRACT PRICE OFWORK R'ti <br />I ZVOL <br />r <br />1 <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOUARE FOOTAGE INED <br />vLP <br />o <br />PROPOSED USE OF _ <br />1K) j.pOF 7 �IfC li% �Ik Ao�f <br />LE ALDESCRIPTION OFPROEPTYISNOWNBELOWOn ATTACHFOURCOPIES <br />P <br />g 19 A ZO Z/ <br />LOT BLOCK 4_Z2 OF �L qT OP f= it64T!LV i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAMETO BE TRUE AND CORRE(,T.ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHERSTATE ORLOCAL LAW REGULATING CONSTRUCTION ORTHE 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 10.27 RCW AND <br />296.200 WAC. <br />SIGNATUREOFFCCq/N�ACTORRO/ORRAAJUif T DATE <br />G ��r nl V,AA. I t'u C.A'u�/r.y <br />-C�ftDS <br />PROJECT ADDRESS <br />.21 4 <br />APPLICANTS CITYBUSMESS LICENSEN ANDOU9NESSNAM <br />D 9 r <T—A(m,'TlOAr <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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <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 />_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONTSETBACK <br />REAR SETBACK <br />SIDESETBAOK <br />PLANCHECKNUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYOROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NOOFSTORIE9 <br />BSMT, <br />D Y <br />DN <br />OCO LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED DYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />-] <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />