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R <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLILATION FOR CONSTFiJCTION <br />PERMIT <br />i <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />D.G. BRANDVOLD 5307 139th Ave S.E. Snohanish 98290 568-9342 <br />MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ST:ohcmish <br />ZIP <br />98290 <br />PHONE LICENSE <br />568-9342 <br />D.G. Brandvold <br />5307 139th Ave S.E. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITV ZIP PHONE LICENSE; <br />Robinson P11s1lbing, Inc. 607 SE Everett Mall Way Everett 98208 355-6171 RDBINP*272C2 <br />CLASS OF WORN <br />.—, I - rl __...-. ...,.., I —I F.D. INRPnT I -I RIIII DING RELOCATION <br />LJ NEW LJ ADDITION L AutnnuUN <br />- <br />CONTACT PERSON AND PHONE NO <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK $2238.00 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />>1 mbul <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT.CT. ALL FRO JISIC NS OF LAVySAND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />LEGAL DESCRI PTIONOr PROPEnrY19110WNBELOWORATTACHFOURCOMESI <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TOE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT !ON OR THE PER- <br />LOT BLOCK OF <br />CONSTRUCTION. THAT I AM AUTHORIZED BY 1 ;TE OWNER OF <br />FORMANCE OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHIC I APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS L.NW 18.27 RCW AND <br />296,200 WAC. <br />SIGNA'UnE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />2831 Marine View Dr. W.r Everett <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />10 <br />00 <br />A/C — AIHNOLG UNITS —H.P. <br />2 <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATHTUB <br />10 <br />OO <br />_ <br />UNIT HEATERS— R.T.U. M <br />2 <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />_ <br />RANGE HOOD <br />DISHWASHER <br />_ <br />— <br />6 <br />50 <br />LAUNDRY TRAY <br />1 <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />10 <br />00 <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />— <br />SINK (SERVICE —BAR, ETC.) <br />- <br />— <br />SUBTOTAL <br />$ <br />30 <br />OO <br />SUBTOTAL $ 6 SO <br />PERMIT $ -2 7G_ <br />PERMIT _ <br />$ <br />—'-3U -GIJ- <br />TOTAL FEE $ <br />TOTAL FEE <br />REAR SETDACK <br />$ <br />SIDE SETBACK <br />PLAN CHECKNUMBER FEE RECEIPT NO. <br />FRONT SETBACK <br />USE ZONE <br />LOT AREA <br />VACANTSIIE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />_ <br />TYPE OF CON9i. <br />OCCUPANCY GRDUP <br />NO. OF DWELLING UNITS <br />ALLOWASLEGCTUAL <br />PLUMBING <br />_ <br />912E OF BLDG. <br />NO. OF STORIES <br />oSYi. <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />IN <br />IIEI014T LIMITATION <br />STATE BUILDING SURCHARGE <br />_ <br />FIRE SPRINKLERS REOUIRED D YES ❑ NO <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICATION ACG BY PLANB APPR BY <br />TOTAL <br />