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r _' : <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DF.PA.RTNIENT <br />259-8810 <br />APPLIC.%,.(ION FOR CONSTR44:TION <br />PERMIT <br />TO BE COMPLE'rED IN INK - PLEASE PRINT <br />T <br />-- MAI: ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CON ACTOR _ — <br />M RMR nIND nFI CK:ATION <br />.NEW ❑ ADDITION LJ ALT ERADON LJ <br />HtYBIn u M=m.."""' <br />CONTACT PERSON AND PHONE NO. <br />1ENANT IMPROVEMENT OR INTERIOR`R�E I.I�OD/EJL�O`!LY <br />CONTRACT PRICE OF WORK <br />pEfCRIBE WORK DSOUAJEF�� EII�ED'/�UM �N <br />f/6�✓ <br />D <br />I HEREBY CERTIFY THAT I HAJE READ AND EXAMINED THIS APPLICATION AND <br />PROM E� SUILDI/NF <br />G/ <br />KNOWTHESAMETOBf TPUE AI'D CORRECT. ALL PROVISIONS OF LAWS AND <br />TYPE OF WORK WILL BE COMPLETED WITH <br />LC <br />ORDINANCES GOVERNINS THIS <br />DOES NOT <br />DESCRIPTION O'"cROPERTYISHOWN BELOW Gl AITACH <br />FOUP COPIESI <br />WHETHERSPECIFIED HEREIN OR NOT.THE GRANTING OF A PER <br />LEGAL <br />PRESUME TO GIVE AUT! IORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OTHER STATE OR LOCAL LAW PER- <br />LGT BLOCK— OF <br />FORMANCEANY <br />OF CONSTRUCION, THATT(I AAMIAUTHORIZED BYTTHI7 OWNER OF <br />THE WORK FOR <br />THIS PROPERTYRCIw ADE <br />YTWTHRFORM <br />AND THE STATE CONTRACTIORSH�4WL18.27 ND <br />0 WAG SIGNAT <br />BIONATURE OF CONTRnCTCR OF AUTHORIp&AO <br />X <br />APPLICANTSG BUSMESE LICENSE NO D INESS NAME <br />OJECT ADDRESS <br />was E✓eeefE r�wou � <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />FEE <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />_ <br />A/C — A/HNDLG UNITS —H.F. <br />WATER CLOSET(TOILEI <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />S4THTUB _ <br />-- <br />UNIT HEATERS—B.T.U. M _ <br />LAVATORY(WASHBASIN) <br />CLOTHES DRYERS <br />—_ <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK& DISP. <br />— <br />RANGE HOOD <br />— <br />DISHWASHER <br />WATER HEATER <br />LAUNDRYTRAY <br />WOOD STOVE <br />CLOTHESWASHER <br />— <br />METAL FIREPLACE II CHIMNEY <br />URINAL <br />— <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />_ <br />HEAT PUMP <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />GAS PIPING _ <br />ROOF DRAINS—PA'VLEADERS <br />_ <br />EXPAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL 5 <br />SUBTOTAL <br />S <br />PERMIT $ <br />P <br />PERMIT <br />5 <br />TOTAL FEE & <br />TOTAL FEE <br />FRONTSETBACK REAR SETBACK <br />S <br />SIDC SCTBAGN <br />PUN CHECK NUMBER FEE RECEIPTNO. <br />FEES VALUATION FEE <br />USE E <br />LOTAREA <br />vACANi SITE <br />❑ VES ❑ NO <br />BUILDING <br />TYPEOFCONST, <br />GCCUPANGVGROUP <br />NO. OF DWELLING UNOS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLDG <br />NO. OF STORIES <br />BOSYT. <br />OCC LOAD <br />MECHANICAL <br />` <br />DN <br />OTHER <br />HEIGHTLIMITATION <br />FIRE SPRINKLERS REQUIRED ❑ YES r NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />IONACCBY PLANS APPR UY <br />APPLICATYI <br />I <br />_ <br />C <br />TOTAL <br />