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APPLIGATION FOR CONSTFJCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />5 <br />OWNE/R MAIL ADUHLSD <br />(-_�FBGF.r S�litf F� 3Sc�- :,-)�+UuJAc� <br />N i'.• _ <br />CLASS OF WORK <br />I1 uccnT n RDII DING RELOCATION <br />LJ NEW LJ ADDITION YJ nutyenvn I- <br />- <br />CON1ACT rE(R/SO,N 4.O PP+14ON.EnE <br />TEHANUM"OVEMENTORINUFT MOODEELLCN�4Y <br />�///-C 2! <br />•NO <br />� !'4� <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CC <br />#-KNOW <br />PROPOSED USE OFBOILDING �)pEREBY <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />711E SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br />/ �LlEAm c'TJ% jZ,'LFl7'.Z 1)G •7�I <br />C 7L /T <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTUJGOFAPERMITDOES NOT <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LEGAL DESC IVTroN OF PaoPERTv(SHOWN eELow Oa ATTACH FOUR coPIEa <br />�.>•'-(p•�7�1 Le�A11T�I�C�Y�1 Ali-C T <br />PRESUME TO GIVE AUTHOQITY <br />LOCAL LAW REGULATING CONSTRUCTION OR THE PER <br />LOi_J�_ BLOCK�iC.�L OFFl1.7�[ILIL• <br />ANY OTHER STATE OR <br />BY THE OWNER OF <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED <br />(� F <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />k �} <br />lfUD lTtu TC 3XrCTT� 3A:0r10bmlmt(CY_yLy-all Ham' /Alt <br />AND I COMPLY WITH 'HE STATE CONTRACTORS LAW 18.27 RCW AND <br />296,200 WAC. �a'.3 OF <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 10 <br />I i <br />r.K'C2/ Q'; f 1= 5AiJ ii:_g_IL�/ TL�v_B[IlYL� PLI. G am_ <br />X Y1)Lc/` 1 / V V L'�'t •i'E'�—' <br />�l <br />AP�ni�JPLIY BUSS NE, fiCENBEN iINE5 M1rA1��C''.'f/YI(SJV/ �lH <br />1 'YAJJ, <br />Pp ^ADORES51, Wj Jr Lam`- r/ /'�% <br />1 � l - .O fT � N 4}l <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIM!IRE OR ITEM <br />FEE <br />NO. <br />F EQUIPMENT <br />FEE <br />WATER CLOSET ITOILEn <br />AiC — AITS — N.P. <br />FORCEL-MS- BT.U. M EA <br />_ <br />BATHTUB <br />UNIT H.T U. M <br />LAVATORY BASIN) <br />_- <br />F <br />_ <br />CLOTH <br />SHOWER <br />VENTIL <br />KITCHEN SINK DISP, <br />__ <br />hnNGE _ <br />DISHWASHER <br />LAUNDRYTRAY <br />WATER <br />CLOTHES WISHER <br />WOODSTOVE <br />METAL FIREPLACE & CHIMNEY <br />_ <br />URINAL <br />- <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />—. <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />- <br />C) <br />- <br />IWSINK(SECE-BAR,E <br />B TOTAL S <br />_ SUBTOTAL S <br />RMIT S <br />PERMIT S <br />TOTAL FEE S <br />FRONT SETBACK REAR SETB,ICK SIDE SETBACK <br />TOTAL FEE /--�., S <br />PLAN CH RECEI NO. <br />LOT/.REA VACANT BQE_ <br />FEES VALUATION FEE <br />U'2 ZONE <br />❑ 'ES O <br />�- L7_-- <br />BUILDING <br />TYPE OF CONST. <br />OCCUp 'GROUP <br />NO CF DWELLING UNITS <br />ALLOWABLE/ACTUAM6' _/ <br />'g . Z a—t <br />om <br />PLUMBING <br />_ <br />SIZE OF BLDG j''Iv <br />le <br />40. OF STORIES <br />BSMT, <br />DCC LOAD ( <br />e_xI 6T� <br />MECHANICAL <br />-- <br />OTHER <br />Gx, s-r <br />I <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIIIED ES 0NO <br />�xJ3T IG <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC By PLANSAPPPR. BY <br />TOTAL <br />x <br />