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APPLICATION FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />i 1 I m 1.1CCOT I —I RUNDWGRELOCATION <br />LJ NEW LJ ADDITION Aj ALItNAIIUN <br />TENANIIMPRWEMENTORINTE TOR NLMODEL OHLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK— <br />SCRIeEWORK NO�°/�RE TAGt NVOLVED <br />/1� I <br />( oNA- <br />Tt 1 UM <br />- <br />PRopoeEDl'BEOiBU1LDIN0 <br />V <br />AND <br />I HEREBY AHAVEND CORK CT. ALL PR VSONSHIS ICATIONOF LAWS <br />KNOWTHE SAME TO BE TRUE <br />OJT <br />L BECOMPLETED WITH <br />ORDINANCES GOVERNING T1141S TYPE OF WORK WILL <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTING OFAPERMITDOES NOT <br />DEBCRIPT)ONOF PROPERTY ISHOWN BELOW OR ATTALII I.U. COPIES) <br />LEGAL <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROklS!ONS OF <br />STATE OR LOCAL LAW REGULATING CONSTRUCTIONOR TIE PEW <br />LOT BLOCK OF <br />— <br />ANYOTHER <br />THAT I AM AUTHORIZED BY THE OWNER OF <br />FORMANCE OF CONSTRUCTION. <br />THIS PROPERTYTHE WORK FOR tHLAW APPLICATIONADE <br />I COMPLYTWITHR TOE STATE CONTRACTORSRM <br />AND <br />296.200 WAG <br />SIGNAYUREOFCONTRAC70RRv.1ORR AAUTHOOII <br />[R}ZZEND AGENT DATE <br />PROTECT ADDRESS �^_1 ,-/ <br />/ <br />C <br />AP ICANISCITYB NESS LICENSE NO AND BUSINESS <br />MECHANICAL <br />PLUMBING. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />A/C — A/HNDLG UNITS — H.P. <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATI ITUB <br />UNIT HEATERS— BTU. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_GAS PIPING _ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC) <br />�— <br />- <br />S=NUMBER <br />UBTOTAL $ 6 <br />SUBTOTAL <br />$ <br />PERMIT <br />SRMIT <br />&FRONT <br />TOTAL FEE <br />ETAL <br />FEE <br />FEE RECEIPTNO. <br />SETBACK <br />REAR SETBACK <br />BIDE BETPACK <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />VALUATION <br />FEE <br />OYES O NO <br />_. <br />TYPE OFCONST. <br />OCCUPANCY GROUP <br />NO.OF DWELLING UNITS <br />ALLOWASLE/ACTUAL <br />PLUMBING <br />MECHANICAL <br />_ <br />Yf <br />SRE OF BLDG <br />NO. OF STORIES <br />BSMT. <br />OCC LOAD <br />O y <br />OTHER <br />_ <br />❑N <br />HEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REWIRED ❑ YE3 ❑ NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ALG BY PLANS APPP BY <br />TOTAL <br />