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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICpB (ION FOR CONSTR64TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARCHITECT OR DEWMER MAIL ADDRESS CITY <br />rvprell <br />e <br />_._ ftz vY� ----- <br />Zip PHONE <br />LICENSE e <br />}t(j)G( Ze. D3 <br />PCLUMBING CONTRACTOR -y MAIL AODRF.SS CITY 21P PHONE LICENSE <br />• <br />F iT�i �irue� f/ _��✓�.nulvcr �r---- 47ci'U�D 77J'7377 �CiT�]GP 0930 Z <br />❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY � CONTACT PERSON AND PiIONE NO. <br />CONTRACT PRICE OF WORK <br />LOT BLOCK___ OF <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 THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER 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 18.27 RCW AND <br />288.200 WAG <br />SIGNATURE OF CONTRACTOR OR AlIT14ORIZED AGENT DATE <br />X �f7 ��2 <br />APPLIGA S61TYDUSI ESYLICENsyNO ANDONSINESS NAME <br />I - <br />/ / <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />/ <br />WATER CLOSET (TOILET( <br />BATHTUB <br />__,L)__ <br />Ci <br />A/C - A/HNDLG UNITS -H.P. <br />FORCED AIR SYSTEMS— BT.U. M EA <br />%i <br />LAVATORY,IWASH BASIN( <br />UNIT HEATERS=B.TM .U. <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 691/1L- <br />) <br />^ <br />VENTILATION FAN <br />DISHWASHER <br />__L <br />RANGE HOOD <br />_ <br />LAUNDRYTRAV <br />WATER HEATER <br />CLOTHESWASHER <br />WOODSTOVE <br />URINAL <br />_ <br />_ <br />METAL FIREPLACE d CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE — BAR, ETC) <br />-- <br />SUB TOTAL <br />S <br />SUBTOTAL <br />$J"ECElffNO. <br />PERMIT <br />$ <br />— <br />PERMIT <br />TOTAL FEES <br />FRONT SETBACK REAR SETBACK <br />1 <br />SIDE SETBACK <br />TOTAL FEE <br />PLAN CHECK NUMBER FEE <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />I I YES IT NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OFALLOWA LEIAC <br />Auow•BLEIAcnul <br />OCCUPANf,YGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLOG <br />NO OF STORIES <br />BSMT. <br />I I Y <br />O N <br />OCC LOAD <br />MECHANICAL <br />_ r" 1� <br />Lin <br />OTHER <br />_....— <br />FIRE SPRINKLERS REQUIRED OYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />r <br />