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APPLICATIuN FOR CONSTRUC'i'ION PERMIT E <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM GAS FJ ELECTRIC LA <br />BUILDING DEPARTMENT <br />259-8810 <br />.J <br />]SIGN <br />T NE I I� MAILAGDRESS CITY ZIP PHONE <br />i <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERA TRACTOHIr MA.I I DRESS I\7 IY ZIP CENSER <br />\Li �.1C I\L! 1 i(�.Y •j\'���' 1/ 1��✓ f J �1 `/ L <br />MECHANICAL C( IIACInII MAIL ADpnESS CITY I� i'\ 11/ ZIP <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP Pll`IONE LICENSE R r/ <br />CLASS OF WORK <br />NEW I !ADDITION j ALTERATION ! I REPAIR I DEMOLITION ! WOODSTOVEIFRPL INSERT 1 1 BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PIIONF 110 <br />r _1 <br />'. �� `�`✓ C' C� <br />DESCRIBE WORK AND SOUAR o rOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING l i 'I I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />L. <br />1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION Or PROPER) Y (SHOWN BELOW On AT ACIT roun coPlPs1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT m.or.K —_ or _ —__ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AU LHORI I 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 or 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 On AU TIIOT(IZED AGENT DATE <br />_X li.l�.�_I �_L� I`_L 1 L'�-��-,_ c v <br />APPI iCTNIS f I I Y nI Nlf;j S 1101"AF: IO AND BUSINESS NAME <br />PROJECT ADDRESS <br />I \ / <br />f-1V C ll- <br />/ <br />----- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMUNT <br />FEE <br />WATER CLOSET (TOILET) _ _ <br />BATHTUB <br />j— <br />A/C ---Al INULG UNI IS -H.P. <br />1 <br />------------' <br />FORCED AIR SYSTEMS-P.T.U. r E.A. <br />UNIT HEATERS-B.T.U. M <br />' <br />i <br />, <br />_ <br />_ _ <br />LAVATORY (WASH BASIN) <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK & DISP <br />; <br />--r- <br />VENTILATION FAN <br />' <br />DISHWASHER <br />_'RANGE hI00D <br />-�— <br />LAUNDRY TRAY <br />_ <br />, ' <br />WATER HEATER <br />1 <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />; <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />—�— <br />DRINKING FOUNTAIN <br />—;— <br />FIREPLACE INSERT <br />; <br />_FLOOR <br />DRAIN <br />BACKFLOW PREVENTERS <br />—~_— <br />�_ <br />_ <br />HEAT PUMP_ <br />GAS PIPING <br />--� <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUST" FAN <br />; <br />SINK (SERVICE -BAR, ETC.)— <br />1 <br />' <br />, <br />1 <br />I <br />, <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT _$_ <br />TOTAL FEE $ <br />Ir <br />PERMIT $ <br />_ <br />I <br />TOTAL FEE $ 1 <br />} ' <br />FOR OFFICE USE ONLY: <br />FRONT SET BACK <br />REARSETBACH <br />SIDESETBACK <br />PLAN CHECK NUMBFn <br />III: <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />--- ---- <br />--- <br />--------->-- <br />IYPEOFCONIS. ALLOWAB,E <br />IYrE OI CONSL ACIUnL <br />acurumr <br />rm rvlmuurm unnx <br />nmm <br />PLUMBING <br />MECHANICAL <br />' <br />SIZE OF BLDG <br />NO.OFSTOnIES <br />BASEMENT <br />.7_J <br />-- <br />occurnNcrLOAD nnEsrnNKLEnsneo0 neu:urilLmm�oN <br />ADDITIONAL PLAN CI IF_CK <br />' <br />, <br />OIIIER "— -- <br />— <br />REASON FOR SPRINKI.FRS <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />PLANSAPPROVEDBY —j <br />CITY OF �VERETT <br />1 <br />LOCAL SALES <br />PLIBL IC WORKS <br />TOTAL <br />7T f <br />TAX CODE IS 3105 <br />