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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />,APPLICA (ION FOR CONSTRUs;TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />N, <br />TENANT <br />MAIL ADDRESS <br />EvEtf?l <br />CITY <br />uvA '25%403 <br />ZIP <br />353�7'/72 <br />P ONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE+ <br />MECHANICA CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBINGCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE+ <br />i <br />1--1 fl nI TFRaTInu I -I REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE N0. 3- 3- -'({7Z TAIAF- <br />CONTRACT PRICEOF WORK <br />/vapK scau, .2 3NV - S✓•+ lam_ <br />DFSSCRIFSSEE AND SQUARE FOOTAGE INVOLVED <br />/WORK <br />-- <br />PROPOSED USE OF BUILD��� <br />1 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 OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />T10N OF PROPERLY (SHOWN BELOW OR ATTACH FOUR COPIE <br />IDESLRIP51 <br />b4 V. <br />PL <br />F L-�w�L <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOTS/Y3Z ��K A OF I�-I- O <br />ANY OTHER STATE ORLOCAL LAW REGULATING CONSTRUCTION ORTHEPER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 897 RCW AND <br />296.200 WAG. Je1 <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 7 --Zp <br />X 750-z"-,L, o S` <br />• <br />PROJECT ADDRESS <br />AI PLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />�✓^ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS -H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />_ <br />L <br />LAVATORY (WASH BASIN) <br />`_—/— <br />UNIT HEATERS-BT.U. M <br />I <br />SHOWER <br />! <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />I'ENTILATION FAN <br />l <br />I <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />1 <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAI NLEADERS <br />EXHAUST FAN <br />SINK(SERVICE- BAR, ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBA K <br />0 <br />PLAN CHEC <br />`L <br />NUMBER <br />`)I <br />RECEIPTNQ <br />o� <br />,S' <br />Ln1ll�g�0 <br />, <br />USEZONE <br />LOT AREA 1 <br />SITE <br />vAES ❑ NO <br />ES <br />FEES <br />VALUATION <br />FE E <br />BUILDING <br />QG Z3`j <br />Oc <br />^ <br />/A..� I <br />Goo / <br />TYPE OF CONST <br />OCCUPANCY GRC'JP <br />NO.OF DWELLING UNITS <br />ALLOWABLE/ACTUA -^( / <br />e _q <br />PLUMBING <br />SIZE OF BLLDDG/. <br />NO OF STORIES BOSMT. <br />oI:O LOAD <br />MECHANICAL <br />nnpp <br />L�6 <br />OTHER <br />-q,7 r <br />HEIGHT LIMITATION <br />FIRE SPRINKLERS REQUIRED C YES O <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC BY PLANS APPR. BY <br />\ <br />\ <br />TOTAL <br />