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L <br />APPLICATION FOR CONSTRu�r N <br />PERMIT <br />IAe Evergreen <br />CITY OF cvereli <br />everett e <br />'t BUILDING DEPARTMENT <br />I 269.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAILADDRESS CITY ZIP PHONE <br />Am Anv h n / 1.ic i / r_.i,,_ 9ro_ 2f z/ <br />I <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />RUMBINOCONTIUCIOP MAILADDRESS CITY ZIP PHONE LICENSE. <br />V1.,, n dnnatn,l ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ 13UILOING RELOCATION <br />TENANT IMPROVEMENT ORINTERIORREMODEL ONLY <br />CONTRACT PRICE OF WORK I svgIov b CT6U <br />CON TACT PERSON ANC PHONE Ila <br />_�✓ooDy �6s.�-Sao 3 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOW ED <br />to -, v 9 <br />PROPOSED USE OF BUILDING <br />l�%Id pr9k <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 />OROI NANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETH ER SPECIFIED HEREI N OR NOT. TH E GRANTI NO OFA PE AM IT 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 PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />298.200 WAG. <br />SIGNATURE OF CONTRACTOR on AUTHORIZED AGENT DATE <br />X 9dcat'� C�TrzLz7 .�c,. Qti?/8//98A <br />LEGAL DESCRIPTION OF PROPERrvISHOWN BELOW oR AIIACN FOUR CDwEsI <br />Lai BLOCK__ OF <br />q v p GIDJ — iY(rGvP, :u,. <br />lip F!('arn �! cI <br />PROJECT ADDRESS 1 <br />�. <br />APPLICANTS CITY BUSINESS LICENSE NO. ANDBUSINESSNAME <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 />_ AIC — A HNOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS —GT.U. MEA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— BTU M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE d CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />_ <br />SACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />__ <br />SINK (SERVICE— BAR, ETC) <br />SUBTOTAL <br />E <br />SUBTOTAL $ <br />_ <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />FRONT SETBACKF <br />REAR SETBACK <br />SIDE SEIBA�K <br />RFA�HCNEC�NumeEn <br />`/vJ tTVA <br />FEE� <br />RECEIPT NO. - I <br />1C5FEE <br />USE ZONE <br />!J � <br />lY� <br />LOT APEA <br />7.0000 <br />VACANT SITE <br />O TES XNo <br />-WO <br />FEES <br />VALUATION <br />BUILDING ' <br />TYPE Of CONS(. <br />ALLOVIABLEIACTUA✓• f A <br />i <br />OCWP NLY GROUP <br />SI,A-/ <br />OF DWELLING UNITS <br />� <br />PLUMBING _ <br />SIZE OF/SLOG, <br />Z7V SF <br />NO.OP SIOMES <br />/ <br />BBML <br />❑ Y <br />N <br />OCC LOAD <br />)VA <br />MECHANICAL <br />OTHER <br />01 <br />l a <br />35 <br />FIRE SPRINKLERS nECUIRED DYES XNO <br />NEIONi LIMITATION <br />Z� <br />STATE BUILDING SURCHARGE <br />APPLICATION. CBY RANS APPR. BT <br />/d/{J4,,, <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />g� <br />Im <br />