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APPLIcI%. ION FOR CONSTR6i6TION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />BE COMPLETED IN, INK - <br />OWNER <br />TENRNi MA1LA CITY RESS _? �O/v ZIP-"-- PHONE <br />'V &Mlr@ _I hf4"WAA/ J/ /Q 1/4- C'Cf~ CT (EA7rLf_ 98/6r-n7-o32/ <br />S I/vre Comer. �7Z c &F— Z_90! 7: q AB 7��6 ek imcg <br />D N ERALCONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE >I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMS14G CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENTOR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK v pe <br />I�Z� � <br />CONTACT PERSON AND PHONE NO /' r <br />t11r� �aNN.Y �%�� JZ7- 0.JZI <br />DESCRIBE WORK AND SQUARE FOOTAGE I I OLVED <br />11NG M <br />PROPOSED S[E�oFIUIL <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 OF A PERMIT OOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE 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 I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRACTOR On AUTHORIZED AGENT DATE 4�714Ry <br />LEGAL DESCRIPTION OF PROPERTY ISIIOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />_ <br />PROJECT ADDRESS <br />APPLUIRTSrny BUSINESS LICENSE NO AND BUSINESS 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 />- <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 />-" <br />VENTILATION FAN _ <br />DISHWASHER <br />F <br />— <br />RANGE HOOD <br />LAUNDRYTRAY <br />�- <br />_ <br />_ <br />WATER HEATER <br />CLOTHESWASHER <br />-' <br />WOOD STOVE _ <br />URINAL <br />_ <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <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 />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />S <br />— <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONTSETBACK <br />REARSETBACK <br />2S' <br />SIDE SETBACK ��t <br />S w <br />CH CKNUMBER <br />FEE �i g <br />� REC�S <br />USEZONE <br />22_ <br />LOTAREA <br />CC 40 <br />VA ANTSHE <br />tglES tJ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF!ONST. <br />ALLOWABLE/ACTUAL �J <br />ri <br />OCCUPANCYGIOUP <br />A-3 <br />NO OF DWELLING UNITS <br />/ <br />PLUMBING <br />TqI� <br />/LLY`Ll <br />SIZEOFBLDG. <br />3o r/ f� <br />NO. OF STORIES <br />/ <br />BSMT. <br />t�rN <br />OCC LOW <br />N1, <br />MECHANICAL <br />OTHER <br />B73 1� /�rjr <br />FIRE PRINKLERS/REEQUIIRRED /`0 YES O <br />HEIGHT LLIIIM17ATPN <br />`� `" <br />STATE BUILDING SURCHARGE <br />D <br />APPLICATION (ICC. BY PLANS APPR BY <br />--`—�JQ17/V,I,/LI1Ya <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />/) <br />O( <br />TOTAL <br />9L <br />11 <br />OC7) <br />L� <br />,14 <br />/71 <br />I Cil hln - # <br />. 7 <br />