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APPLIC.+TION FOR CONSTRICTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />'I CLASS OF MURK 1�.,(, <br />❑ NEW Cl ADDITION IB4 ALjPRrATlnN n RcaAIR I-1 fl ...,._._.,... .....___ m <br />IENANiIMPPOVEMENT ORINi IOn REMODEL N\L1Y <br />-'O—'---• `. .,un.u,,.V nCl VVM11 V1V <br />CO.lNGI PERSON ANO PHONE NO <br />CONTRACT PRICE OF WORK •c <br />DESCRIBE ORKM{DPGUAR GEINVOLVE <br />— <br />M <br />Ip���AV� U ' I <br />PROPOSEDUSEOFBUILDING <br />- <br />—_ — <br />I 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 />LEGAL DESCnIPTION OF PROPERIY(SIIOWN BFLOW OR ATTACH FOUR COPIESI <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />LOL BLOCK or <br />PRESUME 70 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />— <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER. <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY :HE 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 />— <br />296.200 WAG <br />SIGNATURE Or CONTnACTOn On nUiRORIZED AGENT DATE <br />_XVCANISN <br />AP BUSI <br />PROJECT ADDRESS <br />.SSUC SEN A BUSINE SNAA� <br />PLUMBING u <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/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M EA <br />LAVATORY IWASH BASIN) _ <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST EA <br />SINK(SERVICE — BAR, ETC) <br />SUBTOTAL $ <br />SUBTOTAL g QQ <br />PERMIT $ <br />PERMIT $ IT !2D <br />TOTAL FEE $ <br />— <br />TOTAL FEE S 3U <br />FRONT SETBACKREAR SETBACK SIDESEIRACK <br />PUN CHECK NUMBER FEE RECEIPTNO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES 0 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />TYPE OF COHSE <br />CG OUPANLY GROUP <br />NO Ur DWEIIINB UNITS <br />ALLOWABLEJACTUAL <br />PLUMBING <br />-- <br />SIZE OF BLDG. <br />NO OF STORIES <br />BSML. <br />OCG LOAD <br />-- <br />O Y <br />MECHANICAL <br />OTHER <br />_ <br />CD <br />HEIGHT LIMITATION <br />FIRE SPRINKLERS nEOUIRED E' YES D NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />_ <br />APPLICATION ACC BV PLANS APPR. pY <br />PUBLIC WORKS <br />TOTAL <br />L7 <br />