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x C^Fti <br />h7 LsJ <br />9H <br />oxx <br />Q H <br />T xyH rn <br />1-1-3-3 X FBI <br />H H3W <br />Ox0 <br />IVH HC <br />rn H <br />1-3 <br />O H ��yy <br />H�[T7C <br />O. O <br />zy H <br />t' z <br />H H3 <br />S H-I <br />C] C VJ <br />L r <br />HOrA <br />rrA <br />-oft <br />APPLICATIOT.. FOR CONSTRUMiN PERMIT <br />TAP Evergreen TO BE COMPLETED IN INK —PLEASE PRINT I p <br />CITY OF <br />everett HEATING SYSTEM: yB,GAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT = " <br />259 8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />MAR ADDRESS <br />CITY ZIP PHONE <br />ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />•'7�n L ;xdsC Y <br />/ I <br />- ,, S�ct[T Kati <br />/' <br />6V[T c# <br />J(la'LT? <br />T <br />2-r/'%yOF <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />PHONE LICENSE <br />/TLt� i.IUF A"An <br />/ <br />r S-C f / Sf [t//lc fr� <br />/' <br />( 0z"ac/ <br />OZI)P <br />MECHANICAL ANICAL CONTRA��JCrrTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE It <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE. <br />CLASS OF WORN <br />L] NEW ADDITION %`ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PERSONW! PHONE <br />CUN i RACT PRICE OF WORN D <br />/L O <br />DEESnSC119E WORK AND SQUAARE FOOTAGE INVOLVED <br />�RpPOSED USE OF PUMWG <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL..ESCRIPTION OF PROPE TTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 />- <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />— <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONK O UTH091ZEp3AGENT DATE <br />/ <br />-- - <br />X <br />f c�f'I�'1 a 1g' 9L <br />— <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />iY <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />CLOSET (TOILET) <br />AC-AHNDLG UNITS-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEALERS-B.T.U. M <br />SHOWERCLOTHES <br />DRYERSKITCHEN <br />FFEWATER <br />SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOODLAUNDRY <br />TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 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 />1 <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.)— <br />•�z•.^c_ �-cc 5I.mbF <br />_ <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />�I ` <br />FOR OFFICE USE ONLY: <br />FRM-SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBE R <br />I I t <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />--- <br />PLUMBING <br />-- <br />TYPE a CONTS. A.DWABLE <br />TYPE OF CONST ACTUAL <br />DUMMY <br />ANgly <br />NB U WILLING JNITS <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />G r i ri0' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REO'D <br />HEIGHT LIMITATION <br />OTHER <br />i <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />--- <br />�— <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />— <br />�� „� <br />