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APPLIC..TION <br />FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />OF <br />0CITY <br />everett <br />BUILDING DEPARTMENT <br />TO BE COMPLETED <br />IN INK — PLEASE PRINT <br />259-8810 <br />M1IAII AODRL99 <br />—IL.iIY 21P MIONG <br />( <br />lee.)/ <br />f) `!f�I�-L:` <br />•(C`4=-1 �J�J[1 <br />!}+{lI'll, 1. 'C--ZIP._iC-I <br />ln'�( <br />TENANT <br />MAIL ADORLSS <br />ARCHITECT OR DESIGNER <br />MAIL ADDRCSS <br />GTV ZIP <br />GENERAL CONTRACTOR <br />MAII AOORCS9 <br />-- UTY ZIP PHONE <br />NCENSE• <br />CLA590F WORK --_--- — <br />r-. _ n _ T-1 .. nmrnmFRRI INBFRT rl BUILDING RELOCATION <br />U NEW LJ ADDITION w.'ALTEHAIIUN--_--- <br />CONIA CT PERSONANOPNONENO <br />TENANTIMPROVEMENTGRINTERIO REMODEL LILY <br />`' <br />-------- -- <br />COHiPALi PR WORK __—___- __-- <br />_OF <br />DESCRIBE WORK AND SOUAPE FOOTAGE INVOLVED <br />PROPOSED U OF BUILDING —"4 <br />C—: a� L7 <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 H WORK WILL BE COMPLETED WITH <br />SPECIFIED RMEEDOES NOT <br />OFA EPROVISIONS <br />RTY ISIIOWN B[lOW OR ATIACN FOUR FAR[SI <br />LEGAL DESCRIPTION OF PROPEWHETHER <br />RESUME TO GIVE AUITHORIITY TO VVIIOLATE OR CAINCELL THENG <br />OF <br />HER STATE OR LOCAL LAW CONSTRUCTION HE PER- <br />LOT BLocK__OF ------ <br />—"_--ANY01 <br />FORMANCL OF CONSTRUCTIONvI I IATLI AM AUTHORIZED BY THLATING <br />E ORWNER OF <br />I HIS ICATN IS ADE <br />II ROPERTY PERFRM I HE <br />wCONTRACTORS ORK FOR IILAW L1B27 M <br />— <br />COMPLYTO <br />AND W1714 111E STATE RCW AND <br />206 200 WAC. <br />SIGNAIUREOFCONIIDICtFNIUCAEIIIIONIZEDAGENT DATE. <br />XIILL,«)7— <br />_ <br />PROJECtADORESS i 1 rt.O <br />��- <br />— <br />APN IG 1S'IIY BII91NE9511LLNSE NO AND BUSINE93 NAME <br />-1L'fCc �. . q <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />A/C--AlIINUIGUHI75 IIP <br />WATER CLOSET(TOILET)__—__ <br />AIR SI'ST L. IAS -B1.11 T.i LA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />__ <br />_(__FORCED <br />_— <br />I;NITIiEATEFS .-HLU td <br />CLOTHES DRYERS_ <br />VENTILATION FAN <br />SHOWER <br />-- <br />KITCHEN SINK&DISP. <br />_ <br />_ <br />RANGE IIOOD <br />DISHWASHER <br />_ <br />— <br />,—I� <br />WATER HEATER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE&_ CHIMNEY <br />URINAL <br />___ <br />FIREPLACE INSERTFLOORDRAIN <br />_ <br />DRINKING FOUNTAIN <br />_ <br />It EAT PUMP <br />BACKFLOW PREVENTERS <br />---�--— - <br />ROOF DRAINS — RAINLEADEADERS <br />SINK (SERVICE --BAR•ETC! <br />r <br />— <br />_ <br />GAS PIPING <br />EXHAUST FAN <br />.--.---------------------'--- <br />------`__-"- <br />SUB TOTAL _ $__- <br />— <br />— <br />------- <br />— <br />$ <br />SUB TOTAL <br />_ <br />- "_ _ _ <br />__ __. - __ PERMIT _ _$ <br />TOTAL FEE $ <br />NUMB FEE RECEIPT <br />-- <br />PERMIT $ <br />NO, <br />TOTAL FEE $ <br />REAR SETBACK BIDE <br />SETBACK <br />PLAN CHECK <br />FRONTSOBACK <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES D NO <br />—DWELLING <br />BUILDING <br />---------- <br />_ <br />TYPEOFCONST <br />WCUPANCYGROUP <br />NO OF UNITS <br />---- <br />ALLOWABLEJACTOAL <br />PLUMBING <br />— <br />SIZE OF SLOG <br />NO OFSTOPIE9 <br />nYT. <br />DEC LOAD <br />MECHANICAL <br />N <br />OTHER <br />— <br />IlslcuiiiMlrenon <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑YES LINO <br />_ <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION Al:;: BY PLANS APPR BY <br />TOTAL <br />