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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMEAT <br />259•8810 <br />APPLICATION FOR CONSTRICTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS ----jg -pt �7 CITY ZIP PHONE <br />M tW s o,✓ s /117-LL lilty(2 �f a 2 S, C-I �� tJ HsH�� t.A/]A' LRJrr "/9 <br />TENANT MAIL ADOHES5 CITY ZIP PHONE <br />ARCH IT ECT OR DESIGNER MAIUd1DRESS CITY ZIP PHONE <br />/Tc-1z2Y col , n/c, oa eax 52—c 9 98-d `71G 77C. rr 83S <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAILADORESS CITY ZIP PHONE LICENSE It <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />91 ur-w n AnTHTI(7NJ rl AITFRATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />p <br />CONTRACT PRICE OF WORK JI{do, ao �- <br />CONTACT PERSON AND PHONE 140. <br />DESCRIBEWORKANDSQUAREFOOTAGE INVOLVED <br />.�V57�u 271orpl UIRIOL L/T 4R,7-4L S/6AI <br />PROPOSED USE OF BUILDING <br />/Zti']-%i7L S/67L/ <br />I 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 JF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. fHE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OW NER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 10.27 RCW AND <br />290.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />^ F �j--------- /G//C <br />APPLICA S CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />LEGAL GESCR:PTION OF PROPERTY ISIIOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK___ OF <br />-- -- <br />7 O a S �'r 45V%� %%%AZ L. l.,14 ,r % <br />PROJECT ADDRESS <br />PLUMBING <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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEA_ <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRYTRAY- <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_ <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />_ <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESEtBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />Q — / <br />LOT AREA <br />VACANT SITE <br />0 YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLEIACTUAL <br />OCCUPANCYGROUP <br />NO DWELLING UNITS O. <br />PLUMBING <br />SIZE OF BLOG. <br />No, OF STORIES <br />BSMT. <br />D y <br />ON <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPBBY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />