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>H <br />9 ::HDD �HiJ <br />H 3 <br />Ie n <br />H �T <br />MMvil <br />y H <br />z <br />so <br />OH <br />1-3 1 <br />HH <br />H <br />C)dV) <br />CCU�-I <br />1-3 CO2 <br />ROTA <br />,APPLIC.'; JION FOR CONSTRICTION <br />PERMIT <br />MET Evergreen <br />CITY OF of rrriT <br />everett <br />BUILDING DEPARTMENT P�.I �rNG.� Qe�•Z <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT 3 j <br />UWNLI1 _ I MAILADORLSS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAR ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />MECHANICALCONIBACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSIOVFJFRPL INSERT ❑ BUILD114G RELOCATION <br />IENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />OESCRI NVRK AND SQUARE FOOTAGE INVOLVED <br />PRdPotEDusE quILDING <br />I HEREBY CERHFY 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 />W 14ETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAWREGULATING CONSTRUCTION OR THE PERT <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 />2BG.200 WAO <br />2960 Of CONTRACTOn Oil AU11J10nL12W AGENT DALE <br />APPLI rlt$CIbME 5 LICENSCN ESS NAME <br />—1/K—)1 <br />LEGALD IPTIGN Uf PROPERTY ISIIOWN BELOW On ATTACH FOUR CO%EST <br />LOT- BLOCK OF - <br />- - <br />PROJECT ADDRESS <br />,- =sc7 /) //54 � — <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />-EE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />_L <br />N'ATER CLOSET(TOILET) <br />BATHTUB <br />-- <br />A/C —A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS— B.T.U. MEA <br />_ <br />,.� <br />LAVATORY (WASH BASIN) <br />—. <br />UNIT HEATERS— B.T.U. M <br />—L <br />SHOWER <br />_ <br />— <br />CLOTHES DRYERS <br />2r <br />KITCHEN SINK& DISP. <br />�� <br />— <br />_ <br />VENTILATION FAN <br />% <br />h <br />RANGE HOOD <br />_ <br />_DISHWASHER <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHESWASHER <br />WOODSTOVE <br />_ <br />URINAL <br />METAL FIREPLACE& C14IMNEY <br />_ <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACEINSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK (SERVICE — BAR. ETC) <br />SUB TDTAL <br />$ <br />$ <br />_ <br />PERMIT <br />$ <br />_SUBTOTAL <br />_ - _ PERMIT _ $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />_�� <br />— <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMnTA <br />FEE <br />RECEIPTNO, <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />IT YES EI NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPEOFCONST. <br />ALLOWABLVACTUAL <br />OCCUPANCY GROUP <br />NO.OI GAVELLING UNITS <br />SIZE OF OLOG, <br />NO OF stOnIL$ <br />OSME <br />❑ v <br />O N <br />DEC LOAD <br />-- -- <br />OTHER <br />nnE srRINKLEns REWIRED DYES DNO <br />IIEIGIIIIIMITAIION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLAN$APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />