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I <br />u <br />1 <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICraTION FOR CONSTR%,CTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />InRq_INJr <br />V(W 02 <br />E11. 9�01 <br />SrM_acaa <br />TENANT <br />MAIL ADDRE55 <br />CITY <br />ZIP <br />PHONE <br />AMH17ECT OR DESIGNER <br />MAILADDRESS <br />CRY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSED <br />MECHANICALCONTRAOTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />(LASS MRK <br />CUSS OFFWORK ,�,/ <br />rl MPw In ADDITION YALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ 13UILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL r`gLY <br />LONiRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOtAGE 11 WLVEIDI,, <br />lV C. 4 f'1 �A.� <br />PROPOSED USE OF BUILDING <br />_ / <br />I HEREBY CERTIFY THAT I HAVE READ AND 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 />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 I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.2DO WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X } (4tw,.) <br />OF <br />LEaAVL DESCRIP110N PpOPEflTY IBNOW N BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <br />PROJECT ADDRESS j"� —I�Ay <br />/� / <br />APPLICANTS CITY & NESS 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 />j� <br />ArC— A/HNDLG UNITS— H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—RT.U. MEA <br />LAVATORY(WASH BASIN) <br />UNITHEATERS—BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />LAUNDRY TRAY <br />/ <br />RANGE HOOD <br />WATER HEATER <br />/a <br />CLOTHESWASHER <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAI NLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />J <br />SUB TOTAL <br />$ <br />%U <br />SUB TOTAL S <br />.f'Z <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />/O <br />TOTAL FEE S <br />S7i <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AT EA <br />VACANTSITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />/d <br />SIZE OF BUM <br />NO OF STORIES <br />BSMT. <br />❑ Y <br />ON <br />ME, LOAD <br />MECHANICAL <br />,a / <br />S <br />OTHER <br />FIRE SPRINKLERS REQUIRED OYES ONO <br />HEIGHT LIMITATION <br />STATEBUILDINGSURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />3 <br />S e <br />