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APPLICATIOw <br />FOR CONSTRUCT►JN PERMIT <br />the Evergreen TO BE <br />COMPLETED IN INK —PLEASE PRINT <br />i <br />CITY OF <br />everett <br />HEATINGSYSTEM: ❑GAS <br />[ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />LY[E E ��9�/� Vie. �'oX „�aG6 <br />CITY <br />�Ue/� <br />21P PHONE <br />9Jort3 GID <br />TENANT MAIL ADDRESS <br />CITY <br />PHONE <br />ARCHITECT OR LEST ER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERA( CON TRACTjOR� MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />//� GGtJJ?L9� <br />MECHANICAL CONTRACTOR MAII ADDRESS <br />-- <br />CITY <br />ZIP PHONE LICENSE <br />5.s 'vp %y-.s O 4y 3/& <br />PLUMBINGCONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE r.FNSEv <br />,CLWORK <br />.X - ADDITION ALTERATION <br />REPAIR DEMOLITION <br />WOODS( OVE/FRPL INSERT-: BUILDING RELOCATION <br />CONTRACT PRICE <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />/aa91 scar s.F,P <br />CONTACT PERSON AND <br />Gvzro E <br />9�f <br />PROPOSED USE OF BUILDING <br />5_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO IOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHERS ATE ORVLOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF ISPROPERTY WHICH <br />AAPPLICATIONIS MADEE H KR <br />A AND COMPLY WITH THESTATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOROR AUTHORIZED�yGENT DATE <br />/ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK / of _ <br />1 <br />PROJECTyADDREBS / <br />/ Ge4"L U)1�_ Lor 3 <br />P (CANTSCITYBUSINESS IySE N BI S M y/ <br />L- O` <br />PLUMBING <br />ECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) / <br />_ <br />A/C—A/HNDLG UNITS—H.P. <br />9ATHTU3 <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />LAVATORY (WASH BASIN) I/ <br />UNIT HEATERS—B.T.U. M <br />SHOWER 1 <br />CLOTAESDRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />T— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />_ <br />_METAL <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />�— <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $1 <br />SUB TOTAL <br />_ PERMIT $ <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />�— <br />FOR OFFICE USE ONLY: / aS / C1 /5 <br />FRONT SETBACK <br />REAR SETBACK <br />ZO' <br />SIDE SETBACK <br />PLAN CHE K UMBER <br />4_1q <br />FEE <br />3C <br />RECEIPT NO. <br />/Os"dos <br />USEZONE <br />Lot AR[g <br />S /d <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />--- <br />[;'�� <br /><` <br />TYPC Cf CDNi ALLOWABLE <br />Z-14 <br />TYPE Cf CONS(. ROiUAI <br />I� <br />OLCUMW.v <br />Nar <br />NO D OATUING UNrt3 <br />I <br />PLUMBING <br />I <br />31 <br />SIZE OF FLOG <br />(o20 5,l 7 <br />o St' GP2 <br />NO. OF STORIES <br />BASEMENT <br />o <br />MECHANICAL <br />T- <br />ADDITIONAL PLAN CHECK <br />- — <br />�1 <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />PR _/__ <br />REASON FOR SPRINKLERS <br />OTHER % vO <br />I <br />I <br />STATE BUILDING SURCKARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />' J Id <br />Z • c3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />O i <br />TOTAL <br />