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APPLICATION FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />R <br />ARCHITECT OR DESIGNER <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />P_0. <br />,,GGCNERALCONTRACTOR <br />Yprni2A If 0- S-r <br />MAR ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />LVc4(.�AL'i?-J ��ntr- slue.( <br />MAIL ApDRE55 <br />GL1GMt 341( <br />OILY ZIP <br />Itn-Yl5 �y��u.-rT �..� �1 <br />PHONE <br />Z <br />LICEN Er <br />3114 Iv COS <br />KI-z T3 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE - <br />❑ NEW ❑ ADDITION LI ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE <br />H <br />WORK AND SQUARE FOOTAGE INVOLVED / <br />Vic � <br />PR OPOSED USE OFBWLDINp <br />LC6 / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN ED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCFL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR ON AUTTHHORIZEEDDDAA33ENNTT DATE �O ZS OJ <br />_L T <br />LEGAL DESCRIPTION UFP OPERTY ISHpWN BELOW OR ATTACH FOUR COPIE51 <br />LOT BLOCK OF <br />u" 1 I <br />PROJECT ADDRESS <br />2'13 I �✓cn �,TaaL <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <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 />UNIT HEATERS -BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISK <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR. ETC) <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />& <br />TOTAL FEE 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 />O YES U NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BSMi. <br />❑ Y <br />❑N <br />OCC LOAD <br />MECHANICAL <br />w <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPL•CATION ACC. BY PLANS APPR. BY <br />� ���-Li <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />5 <br />