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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIC" i ION FOR CONSTR4�:TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />iI OWNER MAIL ADDRESS CITY ZIP PHONL <br />� lLn� Jpt Laf�i%r% sf !irTlce sjrli�T bvGx' 9poE d 37-6_Vy <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />evereH <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />ClA55 O <br />TiU.sr�!/jtiri ��wit�2 <br />. F WORK T— <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />I <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOUM E FOOTAGE INVOLVED <br />% S74-11 ,r%,(✓ Be Aloes <br />PROPOSED USE OF BUILDING <br />1 <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 />WH2THER SPECIFIED HEREIN OR NOT. THE GRANTING OF PERMIT DOES 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 LPW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DAT*._yp� <br />LEGAL DESCRIPTION OF PROPERTYlsNowN BELOW OR Al7acH Foup coPlEsl —" <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUS L ENSEfJ AND USINf55 NAME//77JJCC <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 />FORCED AIR SYSTEMS—B.T.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISK <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRYTRAY <br />_ <br />HEATER <br />_ <br />CLOTHES WASHER <br />_WATER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />INSERT <br />FLOOR DRAIN <br />_FIREPLACE _ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />_ <br />ROOF DRAINS— RAINLEADERS <br />_ <br />_ <br />EXHAUST FAN <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />— <br />$ <br />_ <br />_ <br />PERMIT <br />$ <br />r-- <br />_S_UBTOTAL <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />l <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />❑ YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />— <br />SIZE OF SLOG, <br />NO.OFSTORIES <br />BSMT <br />D Y <br />O N <br />OCC LOAD <br />MECHANICAL <br />�- <br />OTHER <br />FIRE SPRINKLERS REQUIRED OYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. DY PLANS APPR B/ <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLIC WORKS <br />TOTAL <br />� <br />v <br />