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APPLICjkdON FOR CONSTRIP.:TION <br />PERMIT <br />the Evergreen rveu9t <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />258-8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />LIAIL ADDRESS — CITY ZIP PHONL <br />OWNER <br />)vLIA (nL�/tc,ap 34L.• lli'iFtoj(r �yA'e'�, L] /-LS33 <br />TENANT MAIL ADDRESS G1Y ZIP PHON[ <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />G-H rP <br />MAIL ADDRESS <br />— -- <br />GTY <br />ZIP <br />PHONE LICENSE• <br />GENERAL CONTRACTOR <br />L'LfRFif <br />1) <br />LSL^'1 Y.iG /✓44Je4K 2.3oD/t <br />NAL�ALlf L� ST, <br />T-(31 IrT(/fUI�O •lcF <br />21P <br />PHONE LICENSE F <br />MECHANICAL LON I RAOTOR <br />MAIL ADDRESS <br />--- <br />CITY <br />--A" <br />Y6 �- """'- <br />' <br />PLUMBINGCONTRACTOR <br />MAII. ADDRB59 <br />CITY <br />E�'Ec+i=rr <br />ZIP <br />1' <br />z5L) ?'60 <br />PAq t1EAr-,c-s <br />3YIt Htlof-IEa <br />.,, I rl IIJRRDT 11 WILDING RELOCATION <br />❑ NEW LJ ADDITION LJ ALTERATION I_l HcrnlH u v <br />_.... <br />CANTPERSON AND PHONE NO <br />TENANT IMPROVEMENT OR INTERIOR R[MODEL ONLY <br />CONTRACT PRICE OF WORK <br />$/Lf o.:U - L rt• fC�'C I' hAc1{u'4 Cif tot -7Y5G - <br />DESCRIBE WORN AND SQUARE FOOTAGE INVOLVED <br />I �ILINI� �OLHl P'+'t I1 QAYNOL.r W�I� y�4 /.I'I tll LIf1H�CY r�r9lrt ---- <br />PROPOSEDUSEOFBUILOING 7 _ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />h +�J%UF rfE ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />LEGAL DESCRIPTION OF PROPERTY ISHONN BELOW OR ATTACH FOURCOPIE51 WHETHER SPECIFIED HEREINOR NOT.THE GRANTING OF A PERMIT DOES NOT <br />LL OPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT 11 d•LL BtocK OF �11�T Of" l-LfTR�' f 7 L' A ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AIA AUTHORIZED BY THE OWNER OF <br />_-- AND I COMPLY WIl!IR THE STATE FORM ]HE WCONTRACTORSORK FOR H AWAPPLICATION 1827RCW AND <br />296 200 WAG. <br />WGNA0111LU1 CONINACT1111 Oq n11111011111D AGENT NAIL 1 Ll -•l.g <br />PROJECT ADDRESS APPLICANI9 CITY DUSINLSSLICENSE NO AND BUSINESSNAME <br />3LfLu of 7A,oxA- — — <br />MECHANICAL <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />FEE NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSETTOILET) <br />A/C - A/IiNOLG UNITS - H.P. <br />BATHTUB F7RCED AIR SYSTEMS- RT.U_MEA -- <br />_ _-- -- ___ <br />LAVATORY (WASH BASIN) •_ — UNii HEATERS— B.T.U, M _ <br />SHOWER - _I_ CLOTHES_ D_RYERS_- -- -- <br />KITCHEN SINKS DISP. _(_ VENTILATION FAN <br />--- RANGE HOOC <br />DISHWASHER --- WATER HEATER--- <br />LAUNDRYTRAY ____._—--------- <br />ASHER _-_- WOOD STOVE -- _.--_ — <br />-1---- ---- CLOTHESW- METAL FIREPLACE& CHIMNEY <br />URINAL -- --- - <br />DRINKING FOUNTAIN - _ _- _FIREPLACE INSERT - <br />FLOOR DRAIN -- — - <br />HEAT PUMP <br />BACKFLOW PREVENTERS GAS PIPING <br />--- - EXHAUST FAN <br />ROOF DRAINS- RAINLEAOERS _- __-_ ___- -------------- -- -- <br />SINK (SERVICE --BAR, ETC) - ------------'-- --- — — <br />SUBTOTAL $ _--- — _- _ _ SUBTOTAL _ _ --- <br />PERMIT $ — _ ___ -_ PERMIT _ S _ <br />$ TOTAL'EE $ <br />TOTAL FEE <br />FRONT SETBACK RCAR SETBACK SIDESETBACK <br />PLANCHEC —NUMBER FEE RECEIPT NO. <br />USEIONE LOT AREA aYES ❑ NO <br />9ITE FEES VALUATION FEE <br />YES <br />BUILDING <br />TYPE OF CONST. OLCUPANCYGROUP NO OF DWELLING UNITS —--------- <br />ALLOWABLE/ACTUAL PLUMBING <br />SIZE OF BLDG. NO.OF STORIES B05YT. OCC LOAD MECHANICAL <br />IT N HEIGHT LIMITATION OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO STATE BUILDING SURCHARGE _ <br />STATE ENERGY SURCHARGE _— <br />APPLILATIpN LCC BY PLANSAPPR, BY PUBLIC WORK$ <br />1.�(\vr]jlj.Y`ATgYI\ TOTAL <br />