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APPLICbfION FOR CONSTR6CTION <br />PERMIT <br />the Evergreen everett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TENANT MAIL AVUHLaa Um —1 <br />,5DA)6- off% •� �6 5s7` �vE�z eyegrQo> asa �s�r <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSES <br />I-1 MFW fl AnnITInN M AITFRATION ❑ REPAIR ❑ DEMOLITION .K WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK NI`SOUARE FOOTAGE INVOLVED <br />PRiffFposfq UlSE OrbUjjDTNG <br />ca <br />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 />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO 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 />SIGNATURE OF CONTRACTOR OR THORIZEO AGEN:T> DATE <br />LE RI OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECTADDRESS <br />V <br />APPOCAN S CITY B INESS LICENSE NO AND -BUSINESS NA ME <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS- B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD _ <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEAOERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />.— <br />— <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />- <br />FRONTSETBACK <br />REAR SETBACK <br />SInE SETBACK <br />PLANCHECKNUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY OR -Up <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG, <br />NO OF STORIES <br />BSMT. <br />❑ Y <br />❑ N <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPF:INKLERS REOUIREU OYES ONO <br />HEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />. APPLICATION ACC BY I PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLIC WORKS <br />TOTAL <br />