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APPLICATION <br />FOR CONSTRU.,TION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everetl <br />everett <br />e <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER <br />ff <br />MAIL ADDRESS <br />fl( <br />CITY ZIP PHONE <br />i50{� �d� 5Eyererl/ <br />3sSs s <br />rl/e.� o �Yf <br />[212 nc�iSf <br />�Nr <br />TENANT <br />MAIL A00 ESS <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY ZIP PHONE <br />GEN1ER1ALQC,O�NTR�ACT�OR <br />MAIL AOURESS <br />CITY ZIP PHONE <br />LICENSE <br />) <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASSOFWORK II�&,,�r Ale riv <br />El NEW El ADDITION It ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK n(:T/ Oy 1 60 <br />CONT TPERSONAND ONEN <br />Its _�I7 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />par,01m loa S <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THI;,-- 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 HEREINOR NOTTHEGRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PR PERTYISMOWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK OF <br />PROJECT ADDRESS <br />950b A , Ederell GcJ2 <br />APP C TS CITY BUSINESS LICENSE NO AND BUSINE NAME <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 />AIR SYSTEMS — B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />_FORCED <br />UN IT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />I WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />AS <br />$ <br />PERMIT $ <br />TOTAL FEE <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />5 <br />RECEIPT NO. <br />NIB <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES <N0 <br />IFEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. � <br />ALLOWABLE/ACWN/�./ <br />/ <br />GCCUPANCYGROUP <br />4-7,1 <br />NO OF DWELLING UNITS <br />1!9 <br />PLUM7IN', <br />— <br />SIZE OF BLDG. <br />Ng <br />NO. OF�70RIES <br />BSMT. <br />N <br />OCC LOAD <br />A40 4gx,,VaL: <br />MECHANICAL <br />OTHER <br />FIRE SPR.NKLERS REQUIRED ❑YESNO <br />H EIGHT LI MITAAION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS APPR BY <br />I�Y1 � � j � <br />�' V� <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />