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APPLICD ION FOR CONSTRaTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />25"810 TO BE COMPLETED IN INK— PLEASE PRINT <br />0iVNER MAIL AD LSS CITY ZIP <br />%�{rcrJp,I .=n/uEST <br />�0 17.7 7s 73' <br />�1/e./LE.zi <br />987.ot <br />TENANT I <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCNRECT OR DESIGNER <br />MAIL ADDRESS <br />COY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />XC M+lZ7-W <br />MMUDDRESS <br />7-RiL(klj& i3Lz� a714 <br />CRY <br />L- ,VNwoBd <br />ZIP <br />9830b <br />PHONE <br />779-3/oG <br />C ICENSfe <br />376KK^/� <br />too <br />TAECNANK CONTRACTOR <br />MAIL AUDRESS <br />CITY <br />ZIP <br />PHONE <br />LIOENSEF <br />HUMONOCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />.� <br />nI rtlnu fT wnnnsTOVE/FRPL INSERT Cl BUILDING RELOCATION <br />LJ NEW u BUUnwn u r-7z `- ......... <br />NANT IMPIgVEMENT OR INTERNNI REMODEL ONLY <br />CO�NTRACTTMMIICE OF WORK <br />CONTACTPERSON AND PHONE NO <br />M•aynrw WiRKANDSQVAARRE FOOTAGE INVOLVED <br />v QF WILDING <br />7L24 �./ _ <br />I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THISAPPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWBAND <br />LED HER THISN TTHEGRANE OF WORK LNGWILOF COMPLETEDWITH <br />WHETHER CES <br />ORDINLEGAL <br />WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMRDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PELF <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 1827 RCW AND <br />296.200 WAG. %' 7/ 9y <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEDAOENT DATE <br />X r <br />OE^G1I N PBOPEATYIBHOWNBELOWOR ATTACH FOUR COME91 <br />7� �/ �� �'dF�EzT <br />LOT-SACCIt� OF —L <br />>O• S / LOT 3 ALL- LDT Lf <br />3 �-07 <br />MID ACT ADDRESS <br />APPLICAN IS CITY BUCIN ES9 LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />000. <br />TYFE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS — ELT .U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE MuJD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR L RAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN _ <br />SINK (SERVICE— BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE E <br />FRONTSETSACK REAR SETBACK SIDE SEi BnGK <br />TOTAL FEE S <br />PUN CHECK NUMBER FEE RECEIPT NO. <br />'JeE 20NE <br />LOT AREA <br />VACANT SITE <br />❑ YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TY'EOFCONST. <br />ALLOWASLE/ACTUAL <br />OCCUPANCYGROUI <br />N60FDWELLINGUNITS <br />PLUMBING <br />W2E OF BLDG <br />NO OF STORIES <br />BsMi. <br />Dv <br />N <br />OCC LOAD <br />-LIMITATION <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REGUIRED ❑ YES ❑ NO <br />HElmrt <br />!PPLICATIONACC. BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />_. mil.,.» ._. .. .,.....„. ..., .,. <br />Tl'�. <br />