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EIOEP�I <br />APP1_ICAelON FOR C®NSTRI..;TI®N <br />PERMIT <br />the Evergreen rT rlcll <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />r UILDI10 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS <br />GTY ZIP PHONE <br />..�..I nr l..r JA4A A/. DPdOP D?. rvg"TrJ GVA•__ <br />MAIL ADDRESS CITY ZIP PHONE LICENSER <br />GENERAL CONTRACTOR <br />MECHANIGLCONTPACIOR <br />MAR ADDRESS CRY ZIP PHONE LICENSER <br />MAIL ADOPESS CITY ZIP PHONE LICENSER <br />PLUMBMO CONTRACTOR <br />n _ rl urnnncTtivF6RP1 INSERT ❑ BUILDING RELOCATION <br />❑ NEW 1% ADDITION LJ ALTERATION LJ KLFAIn u Mcmv�•v• <br />CONTACT PERSON AND PHONE NO <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />00 <br />_ <br />CONTRACT PR ICE OF WORK <br />DESCRIBE WORN AND SOUARE FODTAGEINVOLYED 8•I Z_- <br />�JQ, %./VCK <br />t*,#;; /FNZ L Sl0 •f•F V/I/1R fJR• A�w1r/ <br />,"- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />PROPOSED USE Oi BUILDING <br />KNOW THESAME TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND <br />/a�NDESCRIP110N <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />/IF7 <br />OF PROPERLY ISHOWN BELOW OR ATTACH FOUR COPIE5I <br />WHETHERSPECIFIEDHEREINORNOT.THEGRANTING OFAPERMIT DOES NOT <br />LEGAL <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BLOCK OF jjlcid� <br />II% D. <br />ANY OTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />LOT <br />FORMANCE <br />PROPERTY ON THIPERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND <br />7''0 Td- G[ tY U <br />lmrr W. <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW <br />296.200 WAC <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />Xr Z <br />APR ry GTY BUSMES LIC�IS NC AND BU5 NESSN IJE <br />PROJECT ADDRESS <br />/OLUMBING Al, <br />MECHANICAL <br />FEE <br />NO. TYPEOFEOUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NC—NHNDLG UNITS—H.P. <br />1 <br />WATER CLOSET(TOILET) <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />L <br />BATHTUB <br />UNIT HEATERS —BTU. AtLAVATORY <br />(WASH BASIN <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />_ <br />F <br />KITCHEN SINK& DISP. <br />DISHWASHER <br />I <br />RANGE HOOD <br />_ <br />^' <br />WATER HEATER <br />% <br />LAUNDRY TRAY <br />CLOTHESWASHER <br />WOOD STOVE <br />METAL FIREPLACE &CHIMNEY <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAH, ETC) <br />li <br />$ <br />SUBTOTAL S <br />E <br />PERMIT S <br />SETBACK <br />*PERMIT <br />& <br />SIDE SEIO'K <br />TOTAL <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />EIRONY <br />USE ZO <br />VACANTSITE <br />❑ YES <br />FEES <br />VALUATION <br />FEE <br />-73 <br />/�LVNO <br />BUILDING <br />WPE WOF CONST. OCCUPANCYGROUP <br />NOOFDWELLING UNITS <br />r, <br />ALLOWABLEJACTUAL^ 14 2 _ � <br />JL• <br />PLUMBING <br />SRE OFBLM NO.OFSTORIE9 10SAIT. <br />OCOLDAD <br />uAL <br />MECHANICAL <br />S 'SE &PP Iy <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED OYES 4NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACOBY TANS APPR eY <br />TOTAL <br />