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APPLICATION' FOR CONSTRUCTIC4 PERMIT eveFell <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF eve nett HEATING SYSTEM' ❑ GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />I! DEMOLITION I I COMBINATION I I BUILDING I I MECHAI. • I I PLUMBING I I SIGN <br />OWNERMAIL ADDRESS �CITY��// 2_1P'L PHONE <br />�I^ J �!^ ,✓I TwLi---act qITy ZIP <br />1 Owl/ I PHONEr <br />TENANT AIL AODRES.� - , <br />ARCHITECT OR DESIGNER <br />qgy nh <br />MAIL ADDRESS'" <br />G�'k, <br />Ate„ <br />I <br />CITY ZIP P{HONE <br />GENERAL COIJTR CTOO <br />MAIL ADDRESS <br />t <br />CITr <br />ZIP a PHON4I <br />LICENSER <br />J <br />�{ <br />�1'vnP� (Lmrn / f1Yl <br />— <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY 21P � PHONE <br />ID �'t/ <br />L/-O' <br />PLUMBING CONTRACTOR <br />i/ MAIL ADDRESS <br />CITY ZIP PHONE LICENSE M <br />ulube <br />I n Mcw 1.1 AnnITInN fir Al TFRATION I I REPAIR I I DEMOLITION I..I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />ry1 <br />CONTA H51/pL'F,(L1AN�D P ONE NO,^ <br />QI <br />CONTRACT PRICE OF WORK <br />DE RIBE WORK AND SOUARE FOOTAGE INTLVED n <br />�lS/' <br />dayki <br />In rb✓ ImO(vY4��11 of 35(0' <br />_M e ova <br />PROPOSED <br />I5EOFB LMNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� f <br />I I� �UO FYI /'IOl <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND G THIS TYPE OF <br />NANCES <br />PROVIWORK SWILL SBE <br />LEGA�D RIY7 OF PROPERTY ISH Low OR ATTACH FOUR S) <br />N! a , <br />COMPLETED WIITIH WHET: ER SPECIIFIED HEREIN OR <br />LOT I BLOCK _ OF ll////.•IId11 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 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 />SIGNATURE OF CONTRA O ORA t 0 IZEDAGENT SATE <br />y,r O-1 <br />-- <br />APCI LIP ANT BUSINESSEH ENO. ANO SIN SHAME <br />- <br />PROJECT ADDRESS <br />Ll <br />QX <br />a)l <br />PLUMBING <br />MECHANICAL <br />IJO. <br />TYPE OF FIXTURE- OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER GI, OSET (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 />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CL THES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTI ION FAN <br />. <br />DISHWASHER <br />' <br />RANGE HOOP' <br />_ <br />LAUNDRY TRAY <br />I <br />WATER HEAT <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE ,CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />�T <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />i <br />--- <br />SUB TOTAL $ <br />' <br />SUB TOTAL $_ <br />PERMIT $ <br />_ <br />PERMIT $ <br />_ <br />TOTAL FEE si <br />TOTAL FEE $ <br />cnc, ncClr"C "CC nKil V• \ / <br />FRONTSET"•-^K VV <br />REAR SETBACK <br />i-S77AJC <br />SIDE SETBACK <br />— <br />PLAN CHEC NUMBER I FEE <br />R I (n�33 ' Ssa-r <br />RECEIPT NO. <br />jJ <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />cameo <br />I .cl <br />s(t( / .xJ• <br />I <br />_•i C-b <br />J""` <br />TYPE OF CONTS. ALLOWABLE <br />TYr E OF CONST ACTUAL <br />NGL9PAMGr <br />I NG.GFTAHGINGUMITS <br />GRgrt <br />!� <br />PLUMBING <br />i <br />S2E OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MELHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS REO'D <br />HEIGHT LIMITATION <br />OTHER <br />I <br />1 <br />Z e. <br />REASON F09 SPRINKLERS <br />STATE BUILDING SURCHARGE <br />, <br />4 <br />INTAKE BY <br />PI ANS APPROVED BV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />�— <br />LOCAL SALES <br />CODE IS 3105 <br />TOTAL <br />S'5 I Q(� <br />�� <br />TAX <br />