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APPLICATIOr"TOR CONSTRUCT1(7N PERMIT L' m`I, <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />Llui <br />Cm OF .___ <br />eve nett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC-� <br />BUILDING DEPARTMENT <br />259-88i0 <br />-I DEMOLITION COMBINATION )(BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY AP Fr10NE <br />may <br />a yxa En <br />H z Fes-+ <br />IC O <br />y0 <br />,:a H `4 <br />yxx En tHN <br />t9 O <br />OHS <br />HMO <br />0.. C0 <br />H L'7 <br />g` y <br />H <br />C] L7 Cn <br />2 y Tn <br />y O En <br />i <br />c l <br />TENANT <br />MAIL ADDRESS <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />CITY <br />21P <br />PHONE LICENSE / <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASSOFWORrc uunnncrnVPIFRPI INSERT : BUILDING RELOCATION <br />NEW A ADUUIUN ALILMAnWIY <br />...... <br />CONTACT PERSON AND PHONE NO <br />Z <br />K' 9a0 <br />—2 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />bmr— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OOF PROPERTY ISNOWN BELOW OR ATTACH FOUR LOPIE51 <br />LOr '%F;0 BLOCK .S OF D61 1'7- <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />_ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM'AUTHORIZ-ED 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />VAIMANTS1 <br />PROJECTApDRE55 <br />NYBUSINE SS LICENSE NO AND BUSINESS NAM-_ <br />PLUMOBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />' <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />_ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FOR C)"ILa U,t <br />SETBACK <br />USEZONE <br />UNLT: <br />REAR SEIBALK <br />LOT AREAVACANT <br />SIDE SETBACK <br />SITE <br />PLAN CHE KNUMBER FEEFcllRETNOrFRONT <br />FEES <br />FEE <br />BUILDING <br />TYPE OF COOTS ALLOWABLE <br />TYPE OF CONS7. ACTUAL <br />anivu,Tr <br />xa wOwll`I,1G uviu <br />PLUMBING <br />MECHANICAL <br />512EEOTF.."�„'""��(.K NO. OF STORIES BASEMEM_— <br />—3 <br />OCCUPANCY LOAD TIRE SPRINKLERS REOD HEIGHT LIMITATION <br />— <br />REASON FOR SPRINKLERS <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />Y �J� <br />PUBLIC WORKS <br />INTAKE BY <br />PlAt15 APPROVEp BY <br />CITY OF EVEflETT <br />LOCAL SALES <br />TAR CODE IS 3105 <br />TOTAL <br />R I�C <br />I <br />