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�'' APPLICATION FOR CONSTRUCTION PERMIT <br />Ihe Evergreen <br />CIT' OF <br />everett <br />BUILCING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRIt1T <br />I-; DEMOLITION ' COMBINATION 9f BUILDING MECHANICAL xPLUMBING <br />O`MIER MAILADORESS GTV ZIP PMONE <br />�Tn�in Sfel�ox z60T Rock�fel/tr �✓t �vereft' WAlB'101 2 <br />TENANT MAILADDRE55 GITV ZIP PHONE <br />�� ,�t.1Fox .�60� Roeke-�Iih.A�e.._f"�ev'E� Wi4' 94zoi 259-y9d9 <br />ARCHITcGTONDESIGNER MAILADORESS CITY Z1P PNONE <br />y��n Sfal�Eoz 2�j07�ncke��//r.�14ve Ev�ref7`Id�� 9S?Dl .25�-y987 _ <br />GENERALCONTRRCTOR MAI�ADDNE55 CITV ZIP PIIONE UCENSEs <br />cYotin 5�'tl�ox 2C07 Rotkt�elltr Ave. Cv r�]'��•d 9g10/ 2S�-�/98J N.`4_ <br />MECHANICAL LONTRACTOR M�IL ADDRE55 GTY ZIP P110NE UCENSE � <br />So%n Ste%�yx 2607 /Qockt�iell�r /�vt. �vir�Y`f'� jg.201 �59-y98� (�A <br />Pu�uBINGCONTFACTOR MAILADDRE55 CITV ZIP PNONE UCENSE/ <br />everett <br />e <br />SIGN <br />i-�. NEW L:� ADDITION JC ALTERATION <br />iEN�NT IMPROVEMENT OR �J A A ONLV <br />CONTRACT PflICE OF WOfiN c�/I�3 <br />DESCRIBE WORK AND SOUAR[ FOOT E INVOLVED <br />PROPOSEDUSE <br />LEGPI OCSGRIPTION OF PROPE <br />LOT BLOGK <br />TAt S��tA /E Ne4 <br />PRQIECT ADDRESS <br />/ <br />OELOW <br />_ OF <br />NO. I TYPE OF FI%TURE OR <br />WATER C <br />BATHTUB <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN� <br />ROOF ORAINS—RAI� <br />SINK (SERVICE—BAF <br />FRONTSETBACKI <br />�i-ISII,✓i� . <br />USE ZONE <br />R- N <br />iVPL OF CONS7. ALIOWABIE <br />E�I�7�L <br />OCCl1�ANCY LOAD <br />REASON fOR $PRINK�ERS <br />APPUCATION ACC �Y <br />REPAIR . DEMOLITION �. � WOODSTOVE/FRPL INSERT I' BUILDING RELOCATION <br />I CONTACT PEFSON AND PHONE NO. <br />FOUR <br />FEE <br />T <br />O <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRF.CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T�PE OF <br />VJORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 OH THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNEF OF THIS PROPERTY TO PERfORM THE WORK FOR WHICH <br />APPLICATION IS MACE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />S�GNATUREOFWNTPACTORORAU7NORREOAGENT OATE <br />�� ;'G _� v.� G <br />X 11 / �.i�, _ . , <br />CITY BUSINE55 <br />❑AME <br />RIYII�ML <br />TYPE OF E�UIPMENT <br />AiC—A/HNDLG UNITS—H.P. <br />FOfiCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 ' {' ""' """` <br />PERMIT $ � PERMIT <br />TOTAL FEE S �' � TOTAL FEE <br />REAR SETBACK SIDE SEiB�GK �NF�ME ��/� FE�/ �� /� lZ <br />- � ) � c�•) —]• <br />,N �N <br />uLOT AREA VACANT SITE FEES VALUATION <br />7�i 5 96 .S F '� ' YES i: ND BUILDING �� <br />iVPE OF CONSi.0.GiUA � i/ �u=�Ntr NO orm�twrvcuNns � <br />/y auo I pLUMBING <br />NO. F STORIES BASEMENi MECHANICAL <br />'� j( YES � �. NO - <br />FIRE SPRNKLERS REO'D HEIGHi LQIMI�ATION OTHER <br />.�. YES �`1� Z�J STATE OUILDING SURCHARGE <br />STATEENEFGYSURCHARGE <br />°�ANS���� CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 rorn� <br />FEE <br />S 0 ' — <br />$ <br />$ Go ' - <br />7ECEIPT NS?. ,� �� <br />' 7:.!/ 1 <br />t)<J`J <br />FEE <br />3 T- <br />a s'-� <br />��J' OU <br />! <br />,SU <br />� <br />i <br />� <br />� <br />`/G fvv <br />