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APPLICATION FOR CONSTRUCTLoN PERMIT <br />i <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />HEATING SYSTEM: O GAS ❑ ELECTRIC: ❑ <br />C] DEMOLITION C; COMBINATION <br />BUILDING <br />MECHANICAL <br />PLUMBING '_� SIGN <br />OWNER <br />MAILADDRESS <br />CITY <br />Lie <br />rnv..o <br />702 <br />h9u/</cTFo <br />`%8a 75 <br />7k/ 3 <br />P7ARYLZ.L 1,M15 <br />Po r3ax <br />TENANT <br />MAILADDRESS <br />CITY <br />IF <br />PHONE <br />1/-7.22 3 AVECJ <br />F_ye <br />T 9820/ <br />-- <br />ARCHITECT ORDESIGNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />W.IL MORE55 <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />,,, I—— ?/ I ocoAlo -_ nFMnI ITION ' WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO, <br />CONTRACT PRICE OF WORK 19, <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOI ED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />DEG <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />S/A7( LE - - <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIEST <br />LOT 1=_7 BLOCK �_ of tNngF 5 a <br />c ts E <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />-r-HE 5e uz N /C? - - L <br />LL- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />OF LUT 2 EX F 7-71L SmY <br />771 <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEDAGENT DATE <br />!j n <br />PROTECT ADDRESS <br />APPLICANTS CITY BUS SLICENSE NO BUSINESS NAME <br />ti .2-zRp- - I1-k-_,T <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />NC-ATHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY Dr£= P 51 K. <br />S <br />WATER HEATER <br />CLOTHES WASHER <br />S ' <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />( <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE --BAR, ETC.) <br />, <br />I <br />, <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />/-lY 70 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK�JNUMOERtff�� <br />0 `J <br />RECEIPT NO �y <br />�Ji1b <br />a -2'? � <br />%I S7Lo.r <br />USEZONE <br />LOTAREA <br />VAOANTSITE <br />FEESLUATION <br />FEE <br />BUILDING <br />I <br />-f, <br />TYPE OF CONTS. ALLOWAB'.E <br />TYPE OF COME ACTUAL <br />aaW NO IN OwtwKcuvns <br />— <br />BASEMENT <br />PLUMBING <br />_ <br />SIZE OFBLDG. <br />NO, OF .:DRIES <br />MECHANICAL <br />/' :•T <br />ADDITIONAL PLAN CHECK <br />- <br />ILIYIIU(a <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS ROOD <br />HEIGHT LI ITATIONI <br />, <br />Q <br />NO <br />p N 1 <br />OTHER <br />REASON FOR SPRINKLERS <br />I <br />STATE BUILDING SURCHARGE <br />, <br />INTAKE BY PIANO APPROVED BYCITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />4.� TAX CODE IS 3105 <br />TOTAL <br />�p <br />y <br />