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1,/1t=r.1-1 <br />APPLIC„TION FOR CONSTRICTION <br />PERMIT <br />NIB Evergreen <br />PVPfI'II <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />259.8810 <br />OWNER 11 I MAII ADDIil99 Clly 111` <br />1�'1,1-111,1, F 1Clli� > >�i l �( Cilt� t'T t--�iiCt � L'In '� <br />IIP <br />PHONE <br />I _ <br />� j <br />` <br />PHONE <br />TENANT <br />M MLADDRES9 j1 CITY <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS — CITY ZIP <br />PHONE - --� <br />GENERAL CONTRACTOR <br />AIAII ADOO[99 CITY ZIP <br />PHONE UCEN SE A <br />..., <br />mmuri.:✓iiF LICENSE. <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION LTE <br />TENANT IMPROVEMENT ORINTE OR REAIODEI <br />CONTRACT PRICE OF WORK <br />DE :^ ��RK AND SQUARE FOOTAGE INVOI <br />�f-Iy�j.LC_ I L0 <br />LOT <br />BLOCK OF <br />F"1 �cnein r1 nFMn1.ITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />a '1.1 `(TLC 1 <br />)ACT DDRESS <br />'ac I( <br />PLUMBING <br />u^ I TYPE OF FIXTURE OR ITEM <br />DISP. <br />URINAL _— - <br />DRINKING FOUNTAIN <br />FLOOR DRAIN _ <br />— RAINL <br />— BAR, <br />1 HEREBY CERTIFY THAT I 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 EA PERMIT DOES NOT <br />PRESUME TO GIVE AUITHORIITY TO VVIIOLA E OR CAINCEL THE PROV SIIONS OF <br />ANY OUTER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />ANID IROPERTY COMPLYTWTHH THEN TI IE WORK FOR STATE CONTRACTOIRSFILAW APPLICATION <br />MADE <br />WAND <br />296.200 WAG. <br />SIGNATURE OF CONIDACTOII OR AUTHORIZED AGENT DATE <br />APPL�I6YL11Y DU9INESS IIC� D�Afa08U51NES5 �iE ��' �� <br />MECHANICAL <br />NO TYPE OF EQUIPMENT FEF <br />A/C— A/HNDLG UNITS— H P. �f-. <br />RANGE HOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />— <br />— SUB <br />TOTAL <br />5 <br />SUBTOTAL <br />9 <br />---- -- PERMIT <br />S <br />PERMIT <br />9 — <br />--- -- TOTAL <br />FEE <br />S <br />TOTAL FEE <br />S <br />PLAN CHECK NUMBER <br />FEE <br />RE <br />FRONT SETBALN <br />REAR SE TBACN <br />910E SETBACK <br />VACANT —SITE SSIT <br />ES <br />FEES <br />VALUATION <br />USE ZONE <br />LOT AREA <br />O YES ONO <br />BUILDING <br />OCCUPANCY _ <br />NO OF DWELLING UNITS <br />TYPE OF CONST, <br />PLUMBING <br />ALLOWABLE/ACIUAL <br />OF BLOC <br />NO OF STORIES INS <br />OCG LOAD <br />MECHANICAL <br />— <br />SIZE <br />OY <br />ON <br />�— <br />HEIGHT LIMIT--- <br />OTHER <br />— <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED <br />❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />_ <br />APPLICATIOI�BY <br />----1 <br />PLANS APPR OY I <br />PUBLIC WORKS <br />TOTAL <br />— <br />