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F, APPLICATION FOR CONSTRUCTINN,N PERMIT <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve rett I HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ _ _ — <br />BUILDING DEPARTMENT <br />259-8810 <br />j DEMOLITION COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />n FR MAIL ADDRESS CITY ZIP PHONE <br />m s <br />JD <br />C3 <br />Pi `° <br />1-4 M <br />��] <br />Rml <br />Rol <br />42 <br />ry� <br />jay N <br />y <br />Wyy� <br />OW <br />Imm <br />i , f <br />TENANT v MAIL ADDRESS CITY ZIP PHONE <br />Q1 a, tkc-DoyFW0ClwfL _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE IT <br />`i�\L T,-\ O W ),-I <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE( <br />�V"ocoAlo f1 FTFMfII ITIETN 16 WOODRTOVE/FFR°L INSERT : BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />-'nod, S — X <br />rS, R <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T;iIS <br />S`A <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <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 />— <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />S TURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROIECTADDRESS <br />oZ1 z'Y vc c Dcorza.LL Av I_..Atsc: <br />w c 1 <br />APPLICANTS Cf!YBUSINESS 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 />AC-AIHNDLG UNITS-H.P. <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />_ <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />_ <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />- <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />i <br />_T— <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />3 O ' vo <br />NCC ^ HOC YYLFI V. <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES I <br />VALUATION <br />FEE <br />BUILDING <br />I <br />I YEE OF OCTETS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />=PA <br />NO aeALwNII UNITS <br />cNwr <br />I <br />PLUMBING <br />SIZE OFBLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />I <br />OTHER <br />--T— <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVELTBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />