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tC CJ <br />H 70 <br />t0{1H h0 <br />(A I[3H'�� <br />1 O M <br />OH <br />Hag <br />YH <br />CHH <br />gca <br />H <br />oeco <br />I@Lr <br />HEt zA <br />HO(A <br />C:. <br />�I <br />A.PI"LICQTIO.. FOR CONSTR UCT►.jN PERMIT <br />TO BE COMPLETED 1N INK —PLEASE PRINT <br />fde Evergreen <br />CITY OF — — — <br />eve ret{t HEATING SYSTEM: ❑ GAS 'J ELECTRIC ❑ <br />BUILDING DE''DARTMENT <br />259-8810 <br />DEMOLITION !_' COMBINATION BUILDING MECHANICAL PLUMBING _SIGN <br />.. ..oeec CPY ZIP PHONE <br />TENANT 'BAIL <br />ARCHITECT OR DESIGNER MAIL <br />CITY ZIP <br />PHONE <br />CITY ZIP PHONE LICENSE F <br />PLUMBINGCONTRACTOR MAIL ADDRESS <br />CLASS OF WORK _-,LL _.._. ._ - .,.,nemvaraaal INSERT i", BUILDING RELOCATION <br />❑ NEW ❑ ADDITION L'. ALTERATIUN ._ n�rnn y��•--------- <br />CONGA TPERSON AND PHO ENO. <br />�ar i l `t <br />CONTR %CT PRICE OF WORK <br />DESCFIBE WORK AND SQUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />PROIOSEDUSEOFBUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTN)N OF PROPERtt (SHOWN BELOWORATTACHFOUR COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LCT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <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 OF CONTRACTOR ORRAAUTHORIZED DATE <br />1yAGENT <br />PROJECT <br />ADDRESS <br />�3aad <br />APPLICANTS Lltt BUSINESS LICENSE NO. AND BUSINESS NAME <br />pI rj'p. 51-• <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />A/C DLG UNITS—H.P. <br />WATER CLOSET (TOILET) <br />AIEH <br />I <br />FORCED AIR SYSTEMS—B.T.U. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />' <br />CLOTHES DRYERS <br />SHOWER <br />i <br />VENTILATION FAN <br />KITCHEN SINK & DISP <br />RANGE HOOD ' <br />DISHWASHER <br />' <br />WATER HEATER ' <br />LAUNDRY TRAY <br />CLOTHES WASHER I <br />URINAL ' <br />i <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY ' <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />HEAT PUMP ' <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUST FAN ' <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC.) <br />r <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />P <br />PERMIT $ <br />- <br />TOTAL FEE $ <br />TOTALFEE $ <br />' <br />FOR OFFICE USE <br />ONLY: <br />RECEIPT NO, <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK NUMBER FEE <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />USEZONE <br />LOT AREA <br />i <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. AC711A1 <br />amNNAv <br />Ip abARIINGUb15 <br />cnaP <br />PLUMBING <br />MECHANICAL <br />' <br />I <br />SIZE OF BLDG. NO, OF STORIES BASEMENT <br />ADDITIONAL PLAN CHECK <br />A <br />OCCUPANCY LOAD FIRE SPRNKLERS REOV HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />' <br />REASON FOR SPRINKLERS <br />PUBLIC WORKS <br />I <br />INTAKE BY <br />i'lANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />' <br />TAX CODE IS 3105 <br />I TOTAL <br />L% <br />