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APPLICa)'ION FOR CONSTRI,.�TION <br />PERMIT <br />the Evergreen everrtt <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />25ggB81I �h RIP.G Qric, ii OMnE7lcDININK �frr PLEASE /��' 3�0& <br />C01 T E <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DCSIGNER MML ADDRESS CITY ZIP PHONE <br />SILLS f Po. X5I�5 �11 gS�Zc�6 �.Ski131 SNwkIF61 <br />ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 21P PRONE LICENSE <br />rl Aic,. rl AnmTInN ❑ AITFRATION DC AFFAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />OONTREACT PRICE OF WORK ` CV <br />CONTACT PERSON PHONE NO <br />DESCRIBE WORK AND SOU ARE FOOTA EINVOLVED <br />+1T <br />PrgPOSE�uSE OF BUILDING <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 OF WORK WILL BE COMPLETED MTN <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PEP, <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED SY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 16.27 RCW AND <br />296.2DO WAC <br />SIGNATURE OFCONTRACTOROR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROECT ADDRESS <br />0 wAtnuT <br />APPLICANTS CITY BUSINESS ICENSE NO ANDpUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC — AJH NOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EX <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACEINSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <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 />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />vnCANi srtE <br />O YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST, <br />ALLOWABLFJACTUAL <br />OCCUPANCYGROUP <br />NO OFDWELLINGUNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />SSMT. <br />Uv <br />O N <br />OCC LOAD <br />CAL <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOOIRED O YES C NO <br />HEIGHT LIMITATIO14 <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC, BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />