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_e, <br />qUft —1 <br />01111, <br />APPLICATION FOR CONSTRUCTIiON PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 <br />I_] DEMOLITION Li. COMBINATION BUILDING MECHANICAL <br />CITY ZIP <br />PI I IMRING <br />i <br />❑ SIGN <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />LIfY ZIP <br />PNQrve <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />SvNf/E 9&3'1/ <br />PHONE <br />lG.�� 6}ra <br />LICENSED <br />TSBCOI /a�-6p— <br />T�8 L 1st �JG <br />3tFs'f Oceinrar <br />AJe So <br />.m� k cAi rn TRACTOR <br />MAIL ADDRESS <br />_ CITY ZIP <br />_ <br />CITY ZIP <br />,yq Co 817- �taeoLP4ulpLJRt{ ILsYJf Y603/ �57Sy/7 l�x/r�ycyCr•a/r�r <br />vCLASS OF WORK <br />x'NEW I ADDITION &LTERATION i_ REPAIR i_1 OFMOLITION ❑ WOODSTOVE/FRPL INSERT L7 BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE N0. <br />CONTRACT PRICE OF WORK. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED WE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEf.AL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PROIECI ADORERS <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />No <br />WATER CLOSET (TOILET) <br />r0 ' <br />A/C—AIHNDLG UNITS—H.P. ' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />' <br />' <br />CLOTHES DRYERS <br />SHOWER <br />i <br />VENTILATION FAN <br />KITCHEN SINK & DISP <br />DISHWASHER <br />i <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />I <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />' <br />' <br />I <br />I <br />I <br />T <br />SUBTOTAL <br />$ <br />I <br />a0 i <br />SUBTOTAL $ <br />I <br />PERMIT <br />$ <br />/0 I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />RC+R SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES 1-1NO <br />BUILDING <br />' <br />TYPE OF CONSt. ALLOWABLE <br />TYPE OF CDNST. ACTUAL <br />rKwNxcr <br />�pyp <br />Ko. LY MumM <br />PLUMBING <br />I _ <br />3U <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OTHER <br />' <br />OCCUPANCY LOAD FIRESPRNKLERS REOD <br />HEIGHTLIMRATKN <br />' <br />n YES n NO <br />STATE BUILDING SURCHARGE <br />i <br />STATE ENERGY SURCHARGE <br />i <br />REASON FOR SPRINKLERS <br />APPIICATNk1 AC0. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />I <br />o °� <br />TAX CODE IS 3105 <br />TOTAL <br />