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p7 � <br />H <br />9 H-3 cn <br />f< C] <br />h7 c5 <br />yH: y tgg' <br />t+7 O tL1 <br />H d <br />OH <br />HMO <br />40 - CCa.) <br />yz HCO <br />t"HC2T1 <br />t HH <br />t7 ti <br />O H <br />0 t7 vJ <br />rl <br />►_I <br />rl <br />O�1 <br />01 <br />(Ae Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />G <br />,APPLICATION FOR C®NSTrIUCTI®N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�hELU L A-11 \/�� PNONE <br />w-.!I m ., ri I -I wnnnernUEaaPI INSERT ❑ BUILDING RELOCATION <br />11 <br />IENAN I IMPROVEMENT ORINT ERIOn REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONIACi PEAR IBONfANNO PHONENO <br />,Y <br />DESCRIBE WORK AND SCUMS FOOTAGE INVOLVED <br />me 9LDC-,S TALI <br />R <br />PROFOSEDUSEOFBUI DING <br />I HEREBY CERTIFYTHAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />7 <br />J�-�I <br />--- <br />KNOW THE SAME <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOLTHEGRANTING OFA PEPh11TDOE5 NOT <br />LEGAL OE RIPTION OF PR PERtt ISHOWN BELOW OR ATTACIIFOUR COPIESI <br />PRESUMETr GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT BLOCK-- OF <br />I <br />ANYOI HFR;TATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />"ORMANCE OF CONSTRU .TION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PH II MIHE WORK FORWHICHAPPLICATION 18.T RCW ADE <br />THIS 1 CO PL W H TI STATE CONTRACTORS LAW ICATI RCW AND <br />ANDND <br />��J'-// _ � <br />296.200 W '. <br />SIf.NALUR[O .OI RC 1kllEOAGl5N'DATE <br />X8 89PROJECT <br />1Ilo- 7'" ve <br />APPUCMTS Il DUI SS LI WE33 NAME <br />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 />A/C -A/HNDLG UNITS -H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- BT.U. M EA <br />LAVATORY (WASH BASIN) <br />__ <br />UNIT HEATERS -BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />_ <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 PUNIP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR ETC.) <br />-- <br />SUBTOTAL <br />PERMIT <br />S <br />$ <br />SUBTOTAL $ <br />PERMIT $ <br />—� <br />TOTAL FEE <br />$ <br />_ <br />TOTAL FEE $ <br />fWNT BEIBACN <br />REAR BETBACK <br />GIOESEIBAFY. <br />PUN CHICK N MDEG <br />FEE <br />as <br />RECEIPT NO.' <br />�_. B.S. <br />20( <br />i21 <br />121 <br />USEZONE <br />L rinEA `'' <br />VAGWT SITE <br />I<YES <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />p <br />D <br />I(� <br />'/7 <br />_ I <br />4 ' <br />O NO <br />TYPE OF CONST. <br />OCCU ANCYGROUP <br />NO.OF DWELLING UNITS <br />ALLOWASLEIACTUALL <br />n _ I] <br />PLUMBING <br />_— <br />SIZE OF BLOO. <br />T{ Sdg <br />'i <br />NO OF STORIES <br />p <br />SSMT. <br />D N <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />HEIGHT (IMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS RECURRED ❑ YES NO <br />o <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC. BY PLUIS APPR BY <br />` (-[ I> <br />TOTAL <br />V� <br />VvN <br />