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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIt:kAON FOR CONSTRI.-,::TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />JOHN PI. ROBINETT 1001 BROADWAY SUITE A-10 EVERETT WA 98201 252-2500 <br />TENANT MAILAUDRESS CITY ZIP PHONE <br />UNKNOWN <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />HARRY BOTESCH <br />412 ALVERSON BLVD. EVERETT, <br />WA 98201 <br />252-8015 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />UNKNOWN <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />UNKNOWN <br />PLUMBING CONTRACTOR MAR ADDRESS OILY 21P PHONE LICENSER <br />UNKNOWN <br />CLASS OF WORK <br />rX rI n AITPTIATION rl RFPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTER101I REMODELON�LY/ <br />CONTRACT PRICE OF WORK �- - <br />CONTACT PERSON AND PHONE NO <br />K • (� a <br />THEREBY CERTIFY THAT 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 />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYO-.HERSTATE ORLOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANrE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />PCRTYIS <br />AND I OOMOLYTWTHR THE STATE CONTRACTORSRM THE WORK FORH LAWAPPLICATION <br />RCWMADE AND <br />SI GGNAATUTU wAc. <br />SRE OF CONTRACTOR On AUTHORIZED AGENT DATE <br />APPL A SCIIY USINE SLICENS NO. AND r• NAME <br />DESCRIBE WORK ANOSOUARE FOOTAM IN L ED M <br />J�pyr.� / <br />PROS!U-�9BUILDINO0�� U % <br />LEDAL DESCRIPTION F PROPERTY SHOWN BELOW On ATTACH FOUR COPIES) <br />LOT- BLOCK OF <br />BLOCK 671, LOTS 10 1`0A, 11 PLAT OF EVERETT <br />HEWITT AND WEST PIARINE VIEW DRIVE <br />PROJ�AODRE� <br />PLUMQMB3INNG <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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -ELT.U. M <br />SHOWER <br />_ _ <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />_ _ <br />_VENTILATION FAN <br />_ <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOLE <br />URINAL <br />_ <br />_ <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP _ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE - BAR. ETC.) <br />SUBTOTAL S <br />L <br />SUBTOTAL S <br />PERMIT E <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE 5 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK NUMBER <br />S 3 <br />FEE <br />LfoD � <br />RECEIPT NO. <br />S7 <br />US ZONE <br />LOT AREAv' <br />Z KC <br />`nyVZVNTSITE <br />ES D NO <br />- <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />p <br />�/�Tapo <br />/ J/ T <br />TYPEOF CONSi. <br />ALLOWABLEIA,VAL <br />OCCUPANCY GROUP <br />NO.OF UWELLINO UNITS <br />—� <br />PLUMBING <br />—"`j <br />SIZE OF BLDG. <br />It zov <br />NO OF STORIES <br />BSMT. <br />Y <br />OCC LOAO <br />Z� <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYE9 klNO <br />HEIGHTLIMITATION <br />STATE PUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS APPRR B7Y�/-- l! <br />YA C` ad "`' <br />STATE ENERGY SURCHARGE <br />h <br />PUBLIC WORKS <br />TOTAL <br />