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APPLICATIGA FOR CONSTRUCT JN PERMIT n <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />1 <br />the Evergreen <br />CITY OF <br />everett HEATING SYSTEM: S GAS J ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259.8810 <br />❑ DEMOLITION COMBINATION k BUILDING C MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />iJJ,�aJ Z6 Z e t4l,�l� /gym4� %uLrS�. 0!' , e3 la z-'76'-/9 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />CLASS OF WORK <br />17 Naw ADDITION X ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT J BUILDING RELOCATION <br />�j <br />CONTRACT PRICE OF WORK <br />DESCRIDE WORK AND SQUARE FCOTp E INVOLVED <br />Ll <br />CONTAC PERSON AND PN NE NO. <br />PROPOSED USE OF BUILDING <br />/ <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 <br />CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br />REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />ON IS MADE AND I COMPLY WITH THE STATE <br />APPLICATION <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTORORAUTHORIZED AGENT DATE <br />e-oz, <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />LEGAL DESCRI ON OF OPERTY (SHOWN B W OR ATTACH FOUR COPIES) <br />LOTBLOCK (IQ�_ OF <br />J <br />� <br />// il` � <br />OIJ�n n 'O` Ny 7 {Y/ i� O <br />D , <br />/ oo(v aD � O/ <br />PROJECT AODfl SS <br />7 <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 />A/C-AIHNDLG 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 />T <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <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 />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />cr%o nCPICF ims: nm V• wu_c (.. J (lGF.)L B .471, U6'C_ 1951 &J <br />FRONT SETBACK <br />REAR SETBACKv <br />SIDE SETBACK <br />PLAN CHI <br />KNUMB, <br />UB <br />FEE <br />RECEIPT NO. <br />/ r, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OCCupmcy <br />NO OF MELIINGUN17S <br />qW° <br />I <br />PLUMBING <br />51ZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />._ <br />/ <br />ADDITIONAL PLAN CHECK <br />�} <br />Q 1 <br />OCCUPANCY LOAD FIRE SPRNKLERS REDD HEIGHT LIMITATION <br />OTHER <br />1 <br />N 0 <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE By <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J k� <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />;'�� <br />