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APPLICATION FOR CONSTRUCTION PERMIT <br />everett <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEP/,RTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION COMBINATION I 1 BUILDING I 1 MECHANICAL 7 PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />CITY <br />tip <br />PHONE <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DE51G1I211 MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAR ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSED <br />MECHANICAL CONTACTOR MAR ADDRESS <br />CITY <br />ZIP <br />� <br />PHONE yIC EA <br />F:;-ASV <br />u 'L,ok 11�3/,S-/� L1uFti� <br />�� <br />dui lo�J <br />of u..,.n rnuTRACTnR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />.1' 1 n IM V AI TCRATInM I I REPAIR I I nFmoi ITION 1 1 WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORrt: Ci <br />DESCRIBE WORK AND SQUARE DOTAGE INVOLVED <br />�.fjA 1?,�, \ GG <br />712) Gvlt , S <br />PROPOSED USE OF BUNLCINC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOWOR TTACHFOURCOPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOi BLOCK OF _ <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLA-E OR CANCEL THE PROVISIONS OF ANY <br />---1•j�.Q� - �Q��' "—C>IZ <br />—L�_�� <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />—7-1 -1— <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 OFCONTRACTOP.nR AUIHORIZEDAGENT CATE <br />LL.'*L-'4i- Qy0: 7 <br />0.Z. <br />ADDRESS <br />PROJECT ADDRES@��')j �1 <br />1� Q..G� V2, ;7 <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING �'U/�(�V� <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />T <br />WATER CLOSET (TOILET) <br />, <br />ANC—A/HNDLG UNITS—H.P. <br />_ <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 />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK S DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />' <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />N <br />PERMIT $ <br />/ !j <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 />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />' <br />- <br />CI YES I.1 NO <br />TYPE OF CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />ocWPANCY <br />mocP <br />No OP own LING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />I YES I I NO <br />OTHER <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />' <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />T <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVER ETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />