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R <br />APPLICATION'FOR CONSTRUCTRA PERMIT <br />evemtt <br />TO BE (:OMPLETED IN INK -PLEASE PRINT /vAleC <br />(IIR Evergreen <br />CITY OF <br />everett rHEATINGSYSTEM: ❑GAS ELI'G_RIC 0 I <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />PHONE <br />1 MAIL ADDRESS D A �n, Z�0 O <br />a� ��s I <br />(TENANT MAIL ADDRESS CITY 21P PHONE <br />ARCHITECT OR DESgNER MAIL ADDRESS <br />CITv ZIP PNONE <br />PLUMBMGCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />CLASS OF WORK ulnnnCTnUCiVAPI INBFRT BUILDING RELOCATION <br />K NEW ADDIT13,00 ALMMATTUn <br />C T ERSON AND PHONE �1 <br />De, <br />7/ 7 <br />/-�^QO <br />J <br />CGNTPACTPRICEOFWC <br />m <br />SCRIBE K AND SOUARE FOOTP EINVGLVE / <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />pRoroseDu yoF BuwIN <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />J �P A <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DE RIPTN81 OF PROPERTY (SHOWN BELOW OR A1TN;H p COP' <br />BLOCK of F <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />ANY <br />Lot <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />in <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 GONiRACTORONAUTIORM AGENT DATE <br />PROJECT ESS <br />(�LJ7Vi'� <br />APPLICAFITS CITY BUBINE55 LICENBE N0. AND BUBINESS NAME <br />PLUMBING <br />FEE <br />MECHANICAL <br />N0. <br />TYPE OF E OUIPMENT <br />FEE <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A C-ArHNDLG 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 />' <br />I <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />i <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />- <br />A F DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />— <br />I <br />I <br />SUBTOTAL Ett, <br />SUBTOTAL $ <br />PERMIT $ <br />E <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USt <br />VI ILT: <br />PLAN C, UMBEN <br />FEE <br />RECEIPTNO. <br />FRONT SETBACK <br />REARSETBAG0 <br />SIDE SET i <br />1GK <br />nl <br />33� <br />-ZO! <br />FEE(^S_�' <br />VALUATION <br />FEE <br />USE 20N <br />LOT AREA <br />VACANT BITE <br />yy <br />�Z <br />BUILDING <br />Yoo <br />TYPE OT DONIS ALIOWAIIE <br />IF -I J <br />TYR Di WNSI. ACTUAI <br />_ <br />pltyrutr <br />AO rcvA'UIiNGUxii6 <br />/ <br />PLUMBING <br />MECHANICAL <br />i <br />SIZE OF (LOG <br />NO OF STORIES <br />BASEMENT <br />Ibeo Se + <br />ui1 <br />- <br />I <br />'Lso se AM1 <br />ADDITIONAL PLAN CHECK <br />Zip 13 <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REOD <br />HEhiNT LIMI,ATION <br />140 <br />OTHER <br />EASONF RSPRWKLERS <br />STATE BUILDING SURCHARGE <br />'✓C <br />' <br />qo <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />Z <br />Q,1 <br />G� a� <br />LOCAL SALES <br />TAX CODE IS3105 <br />TOTAL <br />�0 i�PZ <br />