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APPLICACION FOR CONSTR6jTION <br />PERMIT <br />the Evergreen <br />CITY OF rvl•uN1 <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK — PLEASE PPINT <br />OWNER <br />JJ MAILADDRESS <br />/(1/ JJ''city .•'l' PIIOME <br />TENANT M ADDRESS -I.Li.`-�+� —� nCtI SIP RIOIII. <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONE <br />GENERAL CON�ACTOR MAIL ADDRESS GTY / IIP RIONE LICENSE e <br />L1LCL� �1(II /6 .,(-d / f. <br />"[E rl �1 _�� fflc� KFuct CR11 <br />MECUAMCAI pW TRAGiD MAIL AD IPCS9 ZIP AIONC LICENSE e <br />R UMBINO CONTRACTOR MAII ADDRESS C.DY III. RIONE LICENSE <br />CA ASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION 29 REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFIiPI. INSERT ❑ BUILDING RELOCATION <br />TENAN I IMPROVEMENT OR INTERIOR nE MODEL ONLY <br />CONTRACT PRICE OF WORK �I <br />--- <br />fDNi�GT PERBON AIID PHONE NO <br />-------- ------ ---- — <br />pESCRIBE WORK AND SpWREF TAGE VEO <br />_-�[� r'-; A � �cJ• � -tom! !ty/��Y c!L_ <br />PRO s DUSE OF RUR DING <br />I,jA <br />LEGAL OE I IiSrYuF PROPERTY RIIOWN BELOW OR ATTACH FOUR CORER — <br />LOt BLDCK____OF --- <br />— <br />PROJECT ADDRESS <br />31 f .r <br />(HEREBY CEFRIFYTHAT I HAVE READ AND EXAMINED THIS APPLIC^T )NANC <br />KI4OW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF U.WS AND <br />OH�INANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHET HER SPECIFIED HEREIN OR NOT THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TOGIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER <br />FORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION I;. MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296 200 WAC. <br />SIGNAIUFIE Of CONI RALIOII 0/1, AUTHORIZED AG, 11 DATE <br />X <br />APPTICANTS C17 Y, C�—�Ntl?nANDBIISINESS NAME <br />PLUMBING <br />MECHANICAL. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />140. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOIL Ell <br />BATHTUB <br />LAVATORY (WASH BASIN( <br />_ <br />A/C-A/HNDLGUNITS-IIP <br />FORCED AIR SYSIEMS_-BT_I MEA <br />UNIT HEATERS--BT.U. M <br />SHOWER <br />KITCHEN SINK E DISR <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOODLAUNDRY <br />WATER HEATER <br />DISHWASHER <br />TRAY <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />_ <br />METAL FIREPLACE a CHIMNEY _ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />_ <br />EXHAUST FAN - -_ <br />SINK (SERVICE- BAR, ETC) <br />- SUBTOTAL E <br />PERMIT E <br />TOTAL FEE $ <br />SUBTOTAL E <br />PERMIT E <br />TOTAL FEE E <br />FRONT SETBACK <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />L07AREA <br />VACANTSITE <br />❑ YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- - <br />PLUMBING <br />TYPE OF CONS( <br />ALLOWABLEIACTNAL <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />SIZE OF FILM <br />NO Of STORIES BSMT. <br />O r <br />IT N <br />OCC EGAD <br />MECHANICAL <br />' <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKI ERB REWIRED U YES a NO <br />[TEIW�11TLIMITATION <br />_— <br />APPLICATION ACC BY PLANSAPPR BY <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLIC WORKS <br />TOTAL <br />