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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />25"810 <br />A <br />APPLIC#I4fION FOR CONSTRI-TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />eveiett <br />e <br />Elm <br />e- r N <br />MAIL ADDRESS <br />I IT - - CRY <br />ZIP <br />PHONE •b��d 1]�_Vji`l1'I <br />/71bW"�•�i77 <br />OENEML CONTRACTOR <br />( <br />I ACTOR <br />ADDRESS <br />CJ�I/T/V/yJ <br />I <br />/EVC`ZI/-p•J•(_//t <br />LICENSE <br />PHONECHANICALCONT <br />C /• <br />PLUM TRACTOR <br />O✓ter <br />MAIL AODRE55 <br />�-- Gr _TY <br />PHONE LICENSE <br />�` ^� Fd d <br />j A/¢I OF WORK <br />[I ❑ REPAIR <br />❑ DEMOLITION WOODSTVEJFRPL <br />❑ BUILDING RELOCATION <br />L DO NEW ❑ ADDITION <br />ALTERATION <br />r PERSON NDP <br />ONE NOSERT <br />IF w . E — <br />j PoeED USE DF RDILDINp / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEDTHISAINS OF LAWS <br />AND <br />3 A / 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 />r LE OEBCRIPTION OF PROPER 'ISHOWN SE LOW OR ATTACH FOUR COPIESI WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OFAPERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BLocK OF ANYOTHERSTATEORLOCAL LAW REGULATING CONSTRUCTION ORTHEPER- <br />Im <br />FORMANCE OF CONSTRUCTION, THAT 1 AM AUTHORIZED BY THE OWNER OF <br />TF IS ADE <br />AND PROPERTY <br />COMPLY TWITHPERFORM <br />STA EWORK CONTRACT'ORSHLAWL182T70RCW AND <br />296.200 WAC. <br />SIGNATURE0 Nt TOR OR AUTHORIZED NT DATE <br />It <br />pppJEGT ADDR� 'A A APPLICANTS CITY BIIBINEBS LICENSE NO. ANp BUBINER3 NAME <br />PIUMBINO / MECHANICAL <br />t FEE NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTJRE OR ITEM ABC —AI UNITS —H.P. <br />WATER CLOSET (TOILET) <br />I FORCED AIR S <br />BATHTUB YSTEMS— 6T.U. M EA <br />LAVATORY (WASH BASIN) UNIT HEATERS—B.T.U. M <br />SHOWER CLOTHES DRYERS <br />VENTILATION FAN <br />KITCHEN SINK6 DISP. RANGE HOOD <br />DISHWASHER WATER HEATER <br />LAUNDRY TRAY WOOD STOVE <br />CLOTHES WASHER — <br />METAL FIREPLACE d CHIMNEY <br />URINAL FIREPLACE INSERT <br />DRINKING FOUNTAIN HEAT PUMP <br />I ROOF DRAINS— <br />SINK(SERVICE— <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />IS <br />PERMIT $ <br />TOTAL <br />FEE <br />$ <br />TOTAL FEE $ <br />FEE <br />RECEIPT NO. <br />REAR SETBACK BIDE SETBACK <br />PUN CHECK NUMBER <br />FRONT SETBACK <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />USE ZONE LOT AREA O YES O NO <br />BUILDING <br />TVPEOFOONST. OCCU PAN Cy GROUP NO. OF DWELLING UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OFBLDG NO.OFSTORIE9 BBMT. OCC LOAD <br />MECHANICAL <br />OV <br />❑ N <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REGUIRED ❑ YES 0 NO <br />STATE ENERGY SURCHARGE <br />APPUCATIONACC BY-7 ANSAPPR BY <br />PUBLIC WORKS <br />a <br />- <br />TOTAL <br />- <br />y <br />