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APPLI"TION FOR CONSTWCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />ARCHITECT OR DESIGNER MAIL pDDRES5 CITY 21P PHONE <br />GENERAL CONTRACTOR MAIL A,RESS CITY ZIP PHONE LICENSE <br />NAM IM EGUIPMO lk ABC <br />..__....._.. __. __. ..._ . ... k. in nnnrcc CITY ZIP PHONE LICENSE <br />EvwMt, W 1982o1 <br />PLUMBING CONTRACTOR /Alai q g MAIL AFkR <br />M n ❑ ❑ WOnORTOVF/FRPL INRFRT ❑ BUILDINO RELOCATION <br />A <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PEPSON AtIp PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />LZCiCG C tllI;(1, <br />C: <br />PROPOSEDUSEOFBUILDING F <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 />GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT <br />WHETHER <br />LEGAL DESCRIPII II OF PROPERttIBNOWN BELOW OR ATTACH FOUR COPIES) <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT BLOCK 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 FCR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE AC/TOR OR AUT140RIZFD AGENT DAIE <br />ON'R <br />c` <br />PRLMECI ADDRESS <br />pPPLICANIS CITY BUSINESS LICENSE NO. AND BUSINESS NAME ^—F <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />_ <br />I <br />FORCED AIR SYSTEMS— B.TU.W')M EA <br />BATHTUB <br />I.AVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />C _OTHES WASHER <br />_ <br />__ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />_ <br />_ <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />I <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />FRONT SETBACK <br />REARSETSACK <br />SIDE SET BACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />WCANTSITE <br />FEES <br />VALUATION <br />FEE <br />O YES ❑ NO <br />BUILDING <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO.OFDWELLINOUNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BL00. <br />NO.OF STORIES <br />Q Y T. <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />❑N <br />IIEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />_ <br />FUBLICWORKS <br />APPUCATIONACG OY PLANS APPR BY <br />TOTAL <br />