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1 <br /> APPLILj, TION FOR CONSTRdCTION <br /> PERMIT <br /> the Evergreen I,YI,I IqI <br /> CITY OF <br /> everett <br /> ,i BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ER MAIL ADDRESS City LIP Fn JE <br /> TtiN (3ALnriz IftCc %Q03 ISIS <br /> NANT MAIL AODRE88 CITY SIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY SIP PHONE <br /> iGENERAL CONTRACTOR MAIL ADDRESS CITY SIP PHONE LICENSEE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY SIP PHONE LICENSE• <br /> PLUM&NGCONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSEE <br /> CLASS OF WORK <br /> T ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ISI WOODSTOVEJFRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOR REMODELONLY CONTACT PERSON AND PHONE NO <br /> CON TRACT PRICE OF WORK: <br /> CiSCRIBE It WORK AN,I' ARE FOOT AGE INVOLVE <br /> t n <br /> ' )P- <br /> ROPOSED USEOF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRECT,ALL PROVISIONS OF LAWS AND <br /> tl LEGAL pESCRIPTION OF PROPERTY BELOW OR ATTACH TOUR COMETS ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> 1 WI I ETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMITDOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> LOT- BLOCK OF 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 FICIN AND <br /> 298.200 WAC. <br /> SIGN ATURE OF CONTRACTOR OR AUTHORISED AGENT DATE <br /> PROqJEC�T ADDRESS APPLICANTS IIYBUSINESSIICCN9E NO AND BUSINESS NAM <br /> I.N� + SN-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET ITOILETI NC—MHNDLO UNITS HH.P.^ <br /> N BATHTUB FORCED AIR SYSTEMS—BT.U. MEA <br /> LAVATORY(WASH BASIN) UNIT HEATERS—BT.U. M <br /> +� SHOWER CLOTHES DRYERS <br /> + KITCHEN SINK S DISP. VENTILATION FAN <br /> 117f DISHWASHER RANOEHOOD <br /> T LAUNDRYTRAY WATER 14EATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE B CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS __ GAS PIPING <br /> j ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> BINK(SERVICE—BAR,ETC) <br /> 1 I <br /> SUBTOTAL S BUB TOTAL S <br /> + ' PERMIT f _ PERMIT i _ <br /> TOTAL FEE $ TOTAL FEE S <br /> I <br /> FRONT SETBACK REAR SETBACK BIDE SETBACK TMANCHECKNUMBLR FEE RECEIPT NO <br /> i USEZONE LOIAREA VACANTSIIE FEES VALUATION FEE <br /> 0 YES U NO <br /> BUILDING <br /> TYPE <br /> TYPE OF CONST. OCCUPANCY GROUP —40 O—DWELLING UNITS <br /> .I ALLOWABLEJACTUAL PLUMBING _ <br /> SIZE OF SLDG. NO OF STORIES 9311f, OCc LDAP MECHANICAL _ <br /> ❑N <br /> HEIGHTLIMIIAIION OTHER <br /> 'I FIRE SPRINKLERS REWIRED DYES 0 N STATE BUILDING SURCHARGE <br /> ,t <br /> 1 <br /> STATE ENERGY SURCHARGE _ <br /> APPLICATION ACC BY PLANE APPR.Br <br /> PUBLIC WORKS <br /> I <br /> TOTAL <br /> i <br /> .iE -.Rr rv•A^•Tc .Y �A� rT <br />