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APPLICATIOd FOR CONSTRUCTION PERMIT <br />0 <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEEM�IOLITI�(O\ N� � El COMBINATION �^j Ell BUILDIN/G///' 'J MECHANICA���Lypp_/� ❑l PLUMBING <br />MAIL ADDRESS <br />n � ✓ .J< I ! ZI L / lD / <br />TENAb[T MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />everett <br />e <br />❑ SIGN <br />GENERAL <br />C NTRAUTGH <br />M <br />' <br />UUHEBB <br />J/�IAIV//Y/G/ <br />Y <br />ZIf1 / <br />E ' /L <br />LICENSE 0 <br />MECHANICAL CO ACTOR <br />MAIL ADDRESS <br />CITY I <br />ZIP <br />PH NE M <br />1/7 <br />,/V6/5LICENSE <br />-, <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE i <br />CUSS OF WORK <br />❑ NEW ❑ ADDITION <br />AL ERATION <br />Cl REPAIR <br />❑ DEMOLITION <br />❑ WOODSTOVE/FRPL INSERT <br />❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR EMODE ONLY <br />CONTRACT PRICE OF WORN: - 0D <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK A 5 ARE FOOTAGE INVOLVED <br />PROPOSIDU UI LNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <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 AUTHORIZED AGENT DATE <br />--i` <br />APPLICANTS CITY BUSINESS L NSE NO. A USINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />— <br />PROJECT ADDRESS Gill <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />------------- <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />, <br />, <br />T <br />SUB TOTAL $ <br />`;UB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />_ i Q <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VAGA14T SITE <br />LI YES 11 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. At LOWABLE <br />TYPE OF CONST. ACTUAL <br />FAN <br />mcUOr <br />Gnouc <br />„GGfmNHI4GGrnTS <br />PLUMBING <br />, <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />I YES I NO <br />MECHANICAL <br />(�I <br />co <br />OTHER <br />, <br />I <br />, <br />OCCUPANCY LOAD FIRE SPRNKLERS RED <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />' <br />STATE ENERGY SURCHARGE <br />—' <br />i <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CIR'OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />r— <br />5S OCR <br />