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CO t>B <br />. ya50000 y <br />HE� <br />y H <br />xz <br />NO <br />ri@g <br />r3 <br />EA <br />H <br />^� a <br />f3GG0 <br />Nlo Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICATION FOR CONSTRU%.TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNER <br />MMLADDRESS <br />CITY <br />ZIP <br />PHONL <br />rr.ITCi�MtL <br />Cu�P 60 60� 3hoGoZ <br />/ <br />GVI=�E�T LJJ4 <br />9uO�F(o <br />ZoG- 8- 6vc, <br />TENANT <br />MAIL ADDRESS <br />GTY <br />ZIP <br />PHONE <br />SAM ( As <br />Ali -WE <br />"Y)HITECTOR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Gill4 <br />��o /Sznl/1 <br />AI/'c �✓(� �,EDnau..IL� <br />9'yuS2-. <br />E>`JZ- lDoc�U <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PMONE LICENSE <br />Llf�i.l LAIJI)Ayl <br />`,iJu Pu 1, 72° <br />P)ELLEv&E L�fi <br />q�Wi'i <br />ysl - f�°v77 <br />n.�GT <br />MECHANICAL CONiMCTOR MMLADDRESS <br />CITY <br />21P <br />PHONE LICENSE <br />1`/�KIti�STR/ <br />C.J. Po PJL)X Z4S(ai <br />SEA-7--C LJr4 <br />%1i17 <br />'bZ-731� <br />PLUMBING CONTMCTO <br />MAIL ADORE55 <br />CITY <br />ZIP <br />PHONE LICENSE <br />r <br />1�7�c��,9,tr� <br />mcv�au <br />CLASS OF WORK <br />❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ElWOODSTOVE/FRPL INSERT ❑ <br />BUILDINGRELOCATION <br />NEW <br />TENANT IMPROVEM ENT ORINTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />COTNTACT PERSON AND PH ONE NO <br />E WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED S OFSUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUEAND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOTTHEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITYTO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHERSTATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC, <br />SIGNATIgREOFCONTRA;TOR R AUTHORIZED AGENT DATE <br />BSI - Li <br />LEGAL DESCRIPTION OF P OPERttISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK OF <br />PROJE00 %SS / <br />G/J/PLUMBING <br />^ <br />APPI SCANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAM <br />br <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ArC- A/HNDLG UNITS -H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />/Q <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />r" <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />- <br />METAL FIREPLACES CHIMNEY <br />(7 <br />DRINKING FOUNTAIN <br />FIREP'' ACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />Zq <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR, ETC.) <br />SUBTOTAL <br />S <br />/] <br />SUBTOTAL $ <br />PERMIT <br />S <br />/U <br />PERMIT S <br />TOTAL FEE <br />S <br />I I d <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPFNO. <br />USEZONE <br />LOTAREA <br />VACANTSOE <br />O YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWASLEJACTUAL <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />_ <br />SIZE OF SLOG <br />NO OF STORIES <br />III <br />❑ Y <br />ON <br />OCO LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED OYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANSAPPRBY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />