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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-9BT0 <br />I tad DTI <br />APPLICION FOR CONSTRU -TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />DINNER MAIL ADDnESS CITY ZIP PHONE <br />FAIL- FAQ -i N C, 61o1(r G-1 Li LT A �it "vG i 7'>'3 Z 7 dZ1 <br />ARCHITECT OR DESIDNER MAIL ADDRESS CRY nP Punwc <br />OENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />��iCr m ccoanic I, _ s Z5 67D <br />MECIIANICALCONiRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />I-AA)Cy- /Y1"lUxAl, VIJ OF CLASS Aee NEW <br />l _ / ,%/U / <br />�q <br />❑ NEW ��,f ADDITION ❑ ALTERATION Cl REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT El BUILDING RELOCATID <br />TENANT IM%IOVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE Of VAORK 3y.5 <br />CONGLi PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />AMC4k /hAAL/,lAt�in m�o11QA f <br />PRDPOBUSE BOIL //��// <br />' MCI Il UfTY/lvrI YYT <br />I HEREBY CERTIFY THAT I HAVE READ AN EXAMINED 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 OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHERSTATEORLOCALL REGULATINGCONSTRUCTIONORTHEPER- <br />FORMANCE OF CONSTRUCT' THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFOR T E. WORK FOR WHICH APPLICATION IS MADE <br />AND I C PLY WITH THE T TIE CONTRACTORS LAW 18.27 RCW AND <br />2BB.200 A . <br />SIGNATURE FC NIF.C10RORA RIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION LS PROPERTY tSHOWN BE LOW OR AR NFOUR COPIE$1 <br />LOT aLocN__ of <br />— <br />t7gJECTAODRES3 <br />71,00 <br />APPLICANTS 11Y9USINE SLICENS NO AND BUSINESS NAME <br />' PLUMSINO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — NHNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— RT.U, M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS — EEJ.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL _ <br />METAL FIREPLACE B CHIMNEY_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVILE — BAR. ETC.) <br />_ <br />SUBTOTAL b <br />SUBTOTAL b <br />PERMIT b <br />PERMIT 5 <br />TOTAL FEE b I <br />I <br />I <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT -SITE <br />O YES ❑ 110 <br />FEES <br />VALUATION <br />FEE <br />TYPE OFCONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITSBUILDING <br />PLUMB;NG <br />SIZE OF BEfK3. <br />NO.OF STORIES <br />BSME <br />u Y <br />O N <br />OOCLOAD <br />MECHANICAL <br />FIRE SPRINKLERS REWIRED ❑YES ONo <br />I IEIGNTLIMIIATION <br />I <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />