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�J <br />s� <br />APPLICATIGA FOR CONSTRUC7.JN PERMIT E'``'IL'`I <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ - <br />COMBINATION BUILDING ❑ MECHANICAL _ <br />.ADORES <br />CRY <br />lJ// ZIP PHONE <br />1 Y�t�Gil ✓ I.PI�G icy Zr"L <br />. n ec DRV ZIP PHONE <br />ARCNRECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING SIGN <br />PLUMBING CONTRACTOR MAILADORESS CITY ZIP PHONE LICENSE <br />n oeeeio n ncL.InI Innis wOODSTOVE/FRPLINSERT G BUILDING RELOCATION <br />CONTACT PERSON AND PHONE N0. <br />V ar d u d <br />CONTRACT PRICE OF WORK • <br />D7/"E WORIjA110 5WA5E FOOTAGE IINOWED <br />/e� 00 �,C_ z ( U U S <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />/ <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />0/77 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR CCPIES) <br />LOT_ BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PPpIECT ADDRE58 /^ <br />/ <br />AP ANTSCIttBUSINEBSICEN NOAND BUSINESSNAME <br />�/73 (A ?Z <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />i <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />I <br />RANGE HOC^ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />' <br />— <br />I <br />� <br />I <br />; <br />SUBTOTAL $ <br />i <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT 5 <br />i <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />cno necire I IeC nKII V. <br />F.9ONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />J� ' <br />i <br />I <br />TYPE OF fANiS. ALLOWABLE <br />TYPE OF CONSL. ACTUAL <br />ocMMrcr <br />NO O{OAfl11N411Nn5 <br />cnwv <br />PLUMBING <br />i <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REDO HEIGHT LIMITATION <br />OTHER <br />I <br />--� <br />_ <br />REASON FOR SPRINKLERS <br />i rG <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUDLICWORKS <br />LOCAL SALES <br />TOTAL <br />TAX CODE IS 3105 <br />