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yHyCDH <br />L7 Crj1� <br />> <br />C H <br />9xaHxtn <br />tHZH <br />KH3w <br />�]HH <br />V1 <br />H tgg" <br />O t+7 <br />OHb <br />Hag <br />F-i (] <br />H Cg <br />9 H t+7 <br />t HH <br />gCA <br />H <br />C] tJ V1 <br />WRLz1 <br />zF3CA <br />H3 O CD <br />APPLICATICA FOR CONSTRUCTi.JN PERMIT <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS Cl ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS DITY ZIP PHONE <br />TENANT MAIL ADDRESS CItY ZIP PHONE <br />ARCHITECT OF DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAR ADDRESS CITY 20/ ZIP PHONE LICENSER <br />.9�iS_ 4W,,vA,0< --e V4/" / / / r: v "1"'- w<>, 901v 9y�gxoy &AfqnE <br />ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE /APO <br />/-I AAId 4- 4-0 co r?) nea c1i 1a -LS-T aw_z -yss-- 93G3 M n <br />'CLASS OF WORK <br />NEW IADDITION ALTERATION REPAIR -1 DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF 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 OR AUTHORIZED AGENT DATE <br />/� t `/' �'"-"'" <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOWOR ATTACH FOURCOPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS �-/ <br />//� n _ 7 c� ��- Sa ti <br />APPLICANTSCITYBUSINESSLICAND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY IWASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I � <br />i <br />I <br />� <br />I <br />SUBTOTAL <br />$ <br />; — <br />SUBTOTAL $ <br />PERMIT <br />$ <br />/e 1— <br />PERMIT $ <br />TOTALFEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />acuwMY <br />WOFmILL11 UNITS <br />GROUP <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />I <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />OTHER <br />I <br />' <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />, <br />TAX CODE IS 3105 <br />TOTAL <br />f <br />