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APPLICATION FOR CONSTRUCTII.A PERMIT jj <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />cirY OF }}}} <br />eVere BUILDING DEPARTMEIJT HEATING SYSTEM: L]GAS UELECTRIC <br />--- <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITYe �` 9ZIP PHONE <br />LYRE E d�frN� ?0. Box ,aaG 6 Tye �'fa43 �ol0 ass <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />P�N.T�MscJ <br />MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSE <br />MAIL ADDRESS <br />NEW ❑ ADDITION l ALTERATION ❑ REPAIR <br />PHONE LICENSE A <br />?IP PHONE LICENSER <br />_ DEMOLITION :. WCODSTOVE/FRPL INSERT ._ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />i0a9 s6 fir- -5.F.P <br />CONTACT PERSON AND PHONE NO // f <br />PROPOSED USE OF BUILDING <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 FERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO IOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE ORVLOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />RFORM <br />OWNER OISPROPERTY WHICH <br />AAPP ICATIONIS MADE PER COMPLY WITH THESTATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED GENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BE: OW OR ATTACH FOUR COPIES) <br />Loi�_ BIOCK_ _ / of/_' �C <br />SL'A /f%%/�GI/ 7r /G %`�7/ <br />PROJECT ADDRESS <br />L <br />r <br />/U�- <br />/I <br />AP (CANTS CITY BUSINESS f{BE N SI S 11 y/ <br />PLUMBING <br />(MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />-FYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB ,i okle r- <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />r— <br />KITCHEN SINK 8 DiSP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLAC❑ 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />/ <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />-T <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTALFEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: - � 5/C- <br />FROIIT SETBACK REAR SETBACK SIDE SETBACK - , PLA�C$ NII E' FEE RECEIPT J . <br />G/1 <br />^�� J/FFETES <br />USEZONE <br />�^ <br />IOT AREA <br />VACANTSITE <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />L'7 a/c?v <br />TYPE Of CONIS ALLOWABLE <br />'IJ <br />TIPS OF COAST. ACTUAL <br />_ <br />CXUP1111 I <br />00,13 <br />'/_ <br />I0 IN 0W[un6 <br />SIZE OF BLDG <br />/o'uA sf-r <br />?< o SF Ci,4 <br />NO. OF STORIES <br />BASFMENT <br />/'10 <br />MECHANICAL <br />//:OI <br />ADDITIONAL PLAN CHECK <br />--T— <br />OCCUPANCY LOAD FIRE S�PR{NKLERS REDD HEIGHT LIMITATID)N' <br />N 4 ✓/CL) / <br />REAS014 FOR SPRINKLERS / <br />OTHER <br />v �1 <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />�)� <br />IOF EVERETT <br />4LSALES <br />FT-iCANX. <br />PUBLIC WORK$— <br />4�ZB�SAf <br />ODE IS 3105 <br />TOTAL <br />r _ <br />