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APPLICATIOW <br />FOR <br />CONSTRUC7,�N <br />PERMIT <br />Evergreen TO BE COMPLETED IN INK -PLEASE PRINT <br />4the <br />CITY OF <br />everett <br />HEATING SYSTEM: GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />C I DEMOLITION COMBINATION <br />BUILDING I I MECHANICAL <br />;PLUMBING SIGN <br />OWNER <br />MAI <br />pDREBB <br />(�+e�ut�ll <br />CITY ZIP PHONE <br />/Y}/-u L�-�I,L <br />L� .)uf <br />iQn <br />MAIL ADDRESS <br />T�EN}-7T <br />CITY IP PHONE <br />L/yi��//IY,/�I•AI�(/�1 <br />ARLMT=.CT OR DESIGNER MAIL AppRE55 <br />CIiY 21P PHONE <br />j#NERAL CONi FACTOq ADDRESS <br />�/F� <br />/ <br />I Z9�T <br />LICENSE( <br />� r /�A <br />111 I <br />t/l <br />`ZIP I1 <br />MECH((AAJNIIC(I,A{ILUO-NTRRACCTTOORR MAIL ADDRESS <br />CITY U <br />L FNE <br />IIA- <br />615-3 ICEN$E • <br />(LIICEENNSS-Ex <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE// <br />CLASS OF WORK <br />I- I NEW I I ADDITION ATION I <br />REPAIR <br />I I DEMOLITION I I WOODSTOVEIFRPL INSERT 11 BUILDING RELOCATION <br />CONTRACT PRICE OF WORK I <br />I 1 -_,T <br />f//�j� . J_ <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WO <ANQ�SQUARE FOOTAGE rVQ�EO <br />PROPOSED USE OF BUILDING <br />' HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 />SIGNATURF. OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />Q1tl« <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />— <br />PROJECT ADDRESS - r -- <br />/,y) <br />l' <br />APPLICANTS CITY BU. ESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—ArHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />�— <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />+ <br />HEAT PUMP <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />�— <br />_I <br />111_ <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />�} <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />�— <br />PERMIT $ <br />/J ' <br />TOTAL FEE $ <br />TOTAL FEE $ <br />,T <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONIS ALLOWAOLE <br />TYPE OF CONST. ACTUAL <br />MCUPANCr <br />Ne W RATTLING UNi IS <br />GB00r <br />PLUMBING <br />i <br />SIZE OF DLDD. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />r <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FINE SPRNKLERS TIED HEIGHT LIMITATION <br />OTHER <br />_ <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 1 <br />TOTAL <br />S U P <br />