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APPLICATI..oN FOR CONSTRUC III ION PERMIT <br />E <br />the Evergreen CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />I I DEMOLITION I I COMBINATION M q"UILDING I I MECHANICAL i )PLUMBING I I SIGN <br />07,�r LMAIL ADDRESS CL",YtI/k CITL� C�P PHONE <br />TENANT AYA/GL MAILADDRESS`CITY / / ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CIT PHONE LICENSE <br />ZIP <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NEW 1-1 AnnITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY J...�/yyy�Jjc 0-4 <br />CO C PERSONA PHONE NO <br />/' ^ Z <br />�(/� <br />CONTRACT PRICE OF WORK: <br />JDCCLL'ZS <br />DEYIBE WORK AND SQUARE FOOTAGE INVOLVcE^D Li= 10CCk!7 <br />PR ED USE OF BUILDING <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />, <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPE RTY)SHOWN BEL OW OR ATTACH FOUR COPIES) <br />LOT3'tL_ BLOCK 54S OF C'L" 3;!.j <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />573' <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 296.20C WAC. <br />SIGNATUREyOF D,(1,�/R <br />OQ��/HO.R..I{�O�ApLGENT <br />njCR <br />1/Iy(,41- '' 7- <br />� /p/A� <br />X /75 i�% TCX/��(}l'C lc'iGfliC <br />PROJECT ADDRESS <br />2 <br />APPLICANTS CITY BUSINt SS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS--E.T.U. M E.A. <br />' <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 />; <br />DISHWASHER <br />.T— <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />�- <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />—�— <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL $ <br />i <br />L <br />SUB TOTAL $ <br />' <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />REAR SETBACK <br />/ <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE _-_ y,Fj <br />So <br />RECEIPT NO. <br />d <br />S <br />017 <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />EES <br />VALUATION <br />FEE <br />-� - <br />Gc-� <br />YES YI NO <br />_ <br />BUILDING <br />0 <br />TYPE OF CONST At I OWABI E <br />TYPE OF CONST ACTIIAI <br />cAl <br />....... <br />, <br />- <br />PLUMBING <br />i <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />� <br />sf <br />I <br />I YES X NO <br />OTHER <br />I <br />OCCUPANCY LOAD FIRE SPRNKLERS RED HEIGHT LIMITATION <br />/ <br />I. I YES IX NO /S <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRINKLERS <br />T— <br />STATE ENERGVSURCHARGE <br />APPLICATION ACC. BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />F <br />Wyo' <br />