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I <br />I <br />APPLIC;�410N FOR CONSTR TION <br />PERMIT <br />Ine Evergreen everetl <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS �CIITY �/ ZIP PHONE p (, <br />-y <br />`1 <br />MAILADORE55 <br />City <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />ZIP <br />PHONE <br />LICENSE • <br />GENERAL CON'T�TRACTOR <br />MAILADDRESS <br />CITY <br />IL . N <br />CITY <br />21P <br />PHONE <br />LICENSE• <br />MECHANNIIlAL00NIRACTOR <br />MAILADDRESS <br />" <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUM�1NGC/ONTRACTOR <br />MAILADDRESS <br />CLASS OF WORK (,�� / <br />rb1 _ f"T lemur I —I RIIILGING RELOCATION <br />LJ NEW LJ ADDITION LJ AL1eHAIIVN u 1 <br />— ------ - <br />CONTACT PERSON AND PHONE NO. <br />TENANT WPROVEM ENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />0 SCRIBEWORKANDSARE FOOTADEINVOLVED <br />O <br />Posen Eo Bello ND <br />I HEREBY THAAND APPLICATION AND <br />ANDCOR . ALL PR VIS AND <br />KNOW THE SAME TO TRUE AND CORRECT <br />KNOWANCES <br />�/J <br />LL(./ZLP' / <br />OF ILL13EICOMPLE COMPLETED <br />ORDINANCES GOVERNING THIS TYPE T IA WORK WILL BF COMPLETED WITH <br />NINGT <br />GOVERNING <br />WHETHER SPECIFIED HEREIN OR NOT.TIIEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />THE PER• <br />L LD IP110N OF PROPERTY ISHOWN 3EL0W OR AiIACH FOUR CO<P�IESI <br />FTIV T�.\� n.L � I <br />OF 1J <br />��.. Y <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />LOT BLOCK ...1 <br />CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />FORMANCE OF <br />TH PIRCOMPLY TWITHPERAP .27TI ORCIWM <br />IiLAW <br />ANID THE STATEWCONTRACTORS 18AAND <br />0 <br />25.200 WAG p9 <br />SIGNAT �OPV <br />OF CONTRACTOR OR AUiIIORIZED AGENT DAZE ``77 GG (( <br />�PROJECT <br />ADDRESS <br />AP ANTS CITY� NESS LICENSE NO. AND OUSINESS NAME <br />—c55ii1 -� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR!TEM <br />._ <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />A/C — A/HNDLG UNITS —H.P. <br />WATER CLOSET(TOILET) <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN <br />UNIT HEATERS—GTU. M <br />CLOTHES DRYERS <br />SHOWER <br />_ <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />— <br />CLOTHES WASHER <br />_ <br />_ <br />WOOD STOVE <br />METAL FIREPLACE& CHIMNEY <br />URINAL <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 />SINK (SERVICE — BAR. ETC <br />— <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTN. FEE $ <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SLTBAGK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />0 YES ❑ NO <br />—GROUP <br />BUILDING <br />TYPE OF CONST. <br />OCCUPANCY <br />WO OF DWELLING UNITS <br />-- <br />ALLOWABLEJACTUAL <br />PLUMBING <br />SIZE OF BLDD. <br />NO.OF 610RIES <br />esLlr. <br />❑Y <br />OCC LOAD <br />MECHANICAL <br />— <br />OTHER <br />❑N <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />— <br />PUBLIC WORKS <br />APPLICATION ACC BY PLANS APPR. BY <br />TOTAL <br />