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APPLICp4TION FOR CONSTRICTION <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 />f�/Soi ?rriiPt�ihPr77s /O4af f✓,,c �� i-✓ %? -r✓3 3 - -� 3 3 <br />CLASS OF WORK <br />YF•--rl NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIIIOTRRRE.MOO'DELONLY <br />CONTRACT PRICE OF WORK ./Z✓I� ��C/C <br />CONTACTPERSON ANDPHONE NO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Hk= 7, <br />PROPOBED USEOFB�UILDI G <br />A� <br />�,1�,Q V�PROPERTY <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 OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION ORTHE 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 ORAUTHORIZED AGENT DATE <br />-{ <br />APPLICANTS CITY BUSINESS LICENSE NO. ANDBUSMESSNAME <br />LEALDESCRIPTIONOF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <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 />s <br />A/C — A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— BTU. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />�.4cf %-uvhec / <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />/5 <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CK NUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />O YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWASLE/ACTUAL <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />&SMT. <br />❑ v <br />O N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED ❑YES ❑NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />�� J� <br />STATE ENERGY SURCHA9GE <br />PUBLIC WORKS <br />TOTAL <br />