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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTM NI <br />259.8810 <br />Iy <br />OWNER <br />j <br />TENA'NTT�—/�-/^"►/ <br />r,. <br />I <br />ARCHITECT OR DESIGNER <br />APPLI"TION FOR CONSTi CTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />l� <br />everett <br />0.ASS Ur W V l /� <br />rl NFw I -I AODITIOIS \ ALTERATION ❑ RFPAIR ❑ DEMOLITtJN ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTI: ?ROVEMENTORII1/7�y/ ERtOOR�)I REMODELO Y ���/\� <br />NICE CONTRACT OF W01j6.� CMG V V <br />CONTACT PERSON AND PHONE NO <br />, <br />DESORIEE WORK AND SQUAREFOOTAGOOTAGEEIINVOLVED <br />PROPOSED USE OF BUILDING <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 PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOL Al E OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY ISIIOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PRO CT�RESS�I ' <br />V I`f'`J1 <br />APPLICANTS CITY B EBS LICENSE I%.M DBUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -- A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS — RT.U,M EX <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE d CHIMNEY <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 />_ <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL $ <br />_ SUBTOTAL $ <br />_ <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />0 YES D NO <br />FEES <br />VALUATION <br />FEE <br />'BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNIIS <br />PLUMBING <br />SIZE OF SLOG. <br />NO. OF STORIES <br />BSMT. <br />❑ Y <br />❑ N <br />OCO LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED 0 YES 0 NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />