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APPLICp-SCION FOR CONSTRI.u.TION <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 />6�Y1� f-isHt(-/ Nab Z.0 o VJD qv6. w• SfATp_E- , ww 2b3-t3e3 <br />evelett <br />e <br />SpeL <br />- <br />ARCGiITECTORDESIGNEF. <br />MAILADDRF.SS <br />CITY <br />ZIP PHONE <br />tyAxTv�- T1ILR- , <br />NLL• <br />GIN ERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP PHONE LICENSE. <br />(A L, <br />Li <br />MECHANICAL CONTRACTOR <br />MAIL ACIRESS <br />CITY <br />ZIP PHONE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />"M NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK: <br />PI C py D/ <br />c- 15zuco <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />NSW �i3 600 % AQiV 5WAr: <br />PROPOSED USE OF BUILDING <br />fAN\IL/L( IV,% IDiTNc_6r <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 NOE THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TC VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGLILATI NO CONSTRUCTION OR THE PER- <br />FORMANCE OFCONSTRUCTION. THAT I .,M AUTHORIZED BY THE OWNER OF <br />COMPLY WITH HISP PRTO OPERTYWHICH 1OM THHE S ATE CONTRACTORSLAW L1827RCWAND <br />AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />Fl , 2� JUG �� <br />PLI NTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OFS <br />�X� 33ae vr�. w. <br />PROJECT ADDRESS <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 />— <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— BT.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />KITCHEN SINK & DISR <br />'— <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />— <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR URAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTAL FEE <br />S <br />�" <br />TOTAL FEE S <br />�� <br />FRONT SETBACK � <br />REAR SETBACK Z-5/ <br />SIDE SFTBADK 7Jf <br />PLAN�CN MBER <br />FEEITB' <br />REC 'IPT NO. <br />USCZONE <br />LOT AREA <br />VACANT$ITE <br />YES 0 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />'VPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />I <br />PLUMBING <br />SIZE OF BLOG, <br />NO.OF 2SI0RIE5 <br />BSM,. <br />U W <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑YES NO <br />HEIGHT LIMITATION <br />STATE BOLDING SURCHARGE <br />APPLICATION ACC BY PLANS APPEL BY <br />IM/�T� <br />" <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />% <br />n <br />n / <br />TOTAL <br />/ <br />l( <br />:_ i—�� <br />