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APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> the Evergreen <br /> CITYOF <br /> everett <br /> BUILDING DEPARTMENT <br /> .. 259.8810 TO BE COMPLETED IN INK— PLEASE PRINT -� <br /> UNNER MAIL ADDRESS CIM1 zip PHONE <br /> EA1 A).U) <br /> I ii 2711—icG sT. sE F116167 9&Z6Sf M <br /> �Y7 TENANT MAILADDRE3S CITY ZIP PHONE <br /> T1 <br /> p y M 1 ARCHITECT OR BUTTONER MAIL ADDRESS CITY ZIP PHONE <br /> 515, <br /> OENEIML CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF {y <br /> H LH { <br /> K (liFt <br /> N—] 'WSJ i MEtMANKAL GF1iRAClOR MAIL ADDRESS CITY IIP PHONE LICENSE• <br /> �H __ <br /> yr PiUM&NG WCT <br /> NlPAOP MAIL ADDRESS CITY IIP PHONE LICENSE <br /> CLASS 01 V.Y1RK <br /> OH NEW <br /> ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ 0,''•OLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br /> O NX-.I _ _ - <br /> [Q V TENANiIMPRpVEMENt OR IN RgTI 700EL ONLY CONTACT PERSON AND PHONE NO � <br /> E{.y� MNTRACT PRIu or woNy Q(/ <br /> 4 H DESCRIBE WORK AND SQUARE FOOT, INVOLVED 3 <br /> H eS/N L r FAm/L l <br /> H N'3 PROPOSED EOE BUILDING <br /> Lj Tp I HEREBY CERTIFY THAT I HAVE READ AND CTA ALL <br /> PR THIS APPLICATION AND <br /> O H ORDITHE SAME TONANCES <br /> GOVERNING <br /> NINGT AND COR OF <br /> ILL BE <br /> IONS OF COMPLEED AND <br /> O C} V1 ORDINANCES GOVERNING THIS TYPE H WORK WILL BE COMPLETED WITH <br /> CQG LEGAL OESLRIPiION UE PROPERM1 I3NOWN BELOW OR AttAL11fOUR COPE31 WHETHER SPECIFIED HEREIN OR NOT.TNE ORANTINOOFAPERMIT GOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVI5IONS OF <br /> [v Loi &MR OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER <br /> N FORMANCE OF CONSTRUCTION THAT 1 AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THEWI FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 298.200 WAG <br /> WNATURE OF CONTRACTOR OR AUTHORIZED AGE NT DATE <br /> X&,zg� UIP <br /> PI�C�ADDRESS <br /> s APE�LICQBCTYBU9IN`59 LIU.CO Nb AND BU9N CNAME Z � <br /> PLUMBING �[, Y/�2c MEC,/HH``ANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIP T <br /> r WATER CLOSET(TOILET) NC—NHNDLG UNITS—M.P. <br /> Z- PATHTUS I FORCED AIR SYSTEMS—HT.U. M EA <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHUWER / CLOTHES DRYERS <br /> Cj KITCHEN SINK B DISP. _ VENTILATION FAN <br /> Ci DISHWASHER RANGE HOOD <br /> I LAUNDRYTRAY WATER HEATER <br /> CLOTHESWASHER WOOD STOVE <br /> URINAL MLTAL FIREPLACE B CHIMNEY 310 c <br /> ISI DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR GRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> - —RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC) —� <br /> SUBTOTAL S _ 9UB TOTAL S <br /> PERMIT S _ PERMIT_ 6 <br /> TOTAL FEE f TOTAL FE S <br /> FRONT SETBACK REAR SEISACK SIDESETBACK FLANCHECKNUMeER FEE RECEIPT WE, <br /> � 0 20 2 <br /> USE LOT u+EAf ' vACANI 5TE FEES VALUATION FEE <br /> S ONO �� � � _ <br /> BUILDING %� _�Li.1L O <br /> TYPE OF CONST. OCOUPANCY plgUP NO OF ME,LINO UNITS <br /> AuowABLErACTuu .3 / PLUMBING <br /> SIZE Of BE W NO Of STORIES ESMT DEC LOAD /n <br /> /N y t8o 5r l.� MECHANICAL `i <br /> HEIGHT LIMIT OTHER <br /> A <br /> FIRE SPRINKLERS REWIRED SEs (I NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> AERKILg10H FGG BYBY PIANS APPR BY 1 . <br /> PUBLIC WORKS <br /> t//T TOTAL �J�- <br />