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-r <br />APPLICATICA FOR CONSTRUCT 90H PERMIT <br />the Evergreen <br />CITY OF <br />eve rett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />❑ DEMOLITION V( COMBINATION ❑ BUILDING 1.1 MECHANICAL <br />EpTUNER �r,, MAI} ADDRESS CITY ZIP PHr,VE <br />mmcP l J,,,2 I'tY"OP 1-7c>9_ 15R-114 :�4 F,PAP qq-r <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />qszamo— — <br />ARCHITECTORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br />I-1 PLUMBING <br />2s 2-& <br />We <br />❑ SIGN <br />��^�^^���^• ...... <br />HHUNE <br />LICENSED <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSED ' <br />LICENSER <br />PLUMBING CONTRACTOR <br />r— <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />CLASS OF WORK <br />'KNEW ❑ ADDITION <br />I I ALTERATION <br />1.1 REPAIR 1-1 DEMOLITION <br />I WOODSTOVE/FRPL,NSERT <br />❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />NO, <br />CONTACTPERSON A/NjL'Q,H, <br />CONTRACT PRICE OF WORK: <br />ZONE <br />��j�T <br />P lJY eA/ �-�Tni e f2S2•-('j ley Z <br />DESCRIBE WORK AND SGUAREF TALE INVOLVED <br />ytoAlac,o 1r0 % Roo <br />a9 <br />PROP ED USE OF BUILOI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN DELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK of <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 LAVI 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 RCC. <br />SIGNATURE OF CONTRACT1;9 <br />X <br />PROJECT ADDRESS _Ir"� <br />APPLICANTSCITYBUBINESSLICENSE NO. AND BU INESS NAME <br />7Dq _(g'•+-�-= <br />PLUM ZING! <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.R <br />, <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />- , <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />�-I <br />WOOD STOVE <br />; <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />�— <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />1 <br />ROOF DRAINS—RAINLEADERS <br />, <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />�— <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />�— <br />PERMIT $ <br />; <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />L1 YES NO <br />BUILDING <br />a�- �70U <br />...7 %Ip� <br />TYPE OF CONST ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />acuPAxcr <br />xo. OFDWmnmuxns <br />DxouP <br />PLUMBING <br />, ' <br />SIZE OF OLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />�— <br />i <br />_ <br />RYES 1.1 NO <br />OTHER <br />- <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS RED HE, IGHT LIMITATION <br />❑ YES 1.1 NO <br />STATE BUILDING SURCHAFGE <br />L.IISD <br />REASON FOR SPRINKLERS <br />-- - <br />STATEENERGYSURCHARGE <br />APPLICATION ACC. <br />APPROVED BY <br />CITY OF EVERETT , <br />PUBLIC WORKS <br />I <br />7NS <br />LOCAL SALES I <br />�- <br />TOTAL <br />ISp <br />TAX CODE IS 3105 f <br />