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APPLICA%g'ION FOR CONSTRIi.:TION <br />PERMIT <br />the Evergreen PvrreU <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�� 4/v __ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />1fon-e <br />GENERAL CONTRACTOR (T MAIL ADDRESS <br />I <br />CITY QZIP PHONE L/CETNSE• <br />" / l�in�iAi"I .rr�if'��.✓cri�---L.i�1A�i <br />PLUMBING CONTRACTOR MAIL AOURESS CITY ZIP PIIONE LICENSEE <br />CLASS OF WORN <br />Cl ❑ TERATION REPAIR DEMOLITION ❑ WOODSTOVE/FRPL INSERT El BUILDING RELOCATION <br />❑ NEW ADDITION AL <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CL <br />G,() <br />�LlS_ <br />CON TACT PERSON AND PHONE NO <br />CONTRACTPRICEOFWORIC <br />!0 <br />DESCRISEWORK AND SQUARE FOOTAGE INVO EO <br />�^ c : i2 S 7 01AI S <br />_ <br />Re <br />p�ED LIE of euILDINo <br />1 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 TH13 TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />LEGAL DESCRIPTION OF PROPERTYIBNOWN BELOW OR ATTACH FOUR COPIES( <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />LOT BLOCK OF <br />ANY OTHER STATE <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 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />I <br />APPLIDANTSCITYe SINESSI ENSEN NO BUBINEBR NAME <br />PROJECT ADDRESS <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/HNOLG UNITS — RR <br />AIR SYSTEMS=B T.U. M EA <br />BATHTUB <br />_FORCED <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE A CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACEINSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />__ <br />_ _ <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />__ <br />EXHAUST FAN___ <br />SINK (SERVICE —BAR. ETC.) <br />— <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK ROAR SETBACK <br />SIDE SETBACK. <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />%VCANT-SITE <br />FEES <br />VALUATION <br />FEE <br />YES ❑ NO <br />_ <br />-DWELLING <br />BUILDING <br />WPE OF CONST, <br />OCCUPANCYGROUP <br />NO OF UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLDG NO OF STORIES BSMI. <br />occ Lo•o <br />MECHANICAL <br />OY <br />❑ N <br />----- - <br />OTHER <br />HEIGHTLIAIRATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED I) YES O NO <br />STATE ENERGY SURCHARGE <br />PUDLICWORKS <br />APPLICATION ACC BY PI ANS APPR BY <br />TOTAL <br />