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APPLICA i ION FOR CONSTRW'TION <br />PERMIT <br />the Evergreen <br />CITY OF PvcrPIl <br />everett <br />BUILDING DEPARTMFNT <br />259-8610 'TO BE COMPLETED IN INK - PLEASE PRINT <br />OWNER MAN ADDRESS CITY ZR` PHONE <br />NO/ZY) Sc,t,/L.Z XSFYA 'FFF./ca� *AZ_ _ EuF iT_ _9Yzcs d53'7°/72 <br />TENANT MAIL ADDRESS CITY SIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />�hAf.Vir/Z.FL. LU�J,'7LNc TD,YS .TUC_ �. Si6 '7014L.V& tV, A-06tfr� 3Y'3-7`ni- NSCUISCA ISO/ <br />MECHANICAL CONT ACTOP 1MIL AGGRESS f CITY ZIP PHONE LICENSE III <br />PLUMBINOCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODELOHLY <br />CONTRACT PRICE OF WORK <br />,p[[s <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />))&tl &AJ ST, C)l S ( fiYIZ <br />PROPOSED USE OF BUILDING <br />_ <br />I HEREBY CERTIFY TI4AT I HAVE READ AND EXAMINED THIS 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 HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER 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 />298.200 WAG <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED ENT DATE <br />Xxe�t,..n. W. SO,. cF-�L-K� <br />LEGAL DESCRIPTION OF PAOPERTYISI,OWNBELOW OR ATTACH FOUR COPIES) <br />LOT I BLOCrc�OFPtM O% PrN 76 <br />PROJECT ADDRESS _) <br />� 10 61 S <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AVHNDLG UNITS —HP. <br />_ <br />BATHTUB <br />_ <br />�- <br />FORCED AIR SYSTEMS — BT.U. M EA <br />LAVATORY (WASH BASIN) <br />'� <br />UNIT HEATERS —BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAU 1RYTRAY <br />( <br />WATERHEATER <br />CLL. 'ESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE f CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE — BAR, ETC) <br />_ <br />SUBTOTAL <br />f <br />SUBTOTAL _ f <br />PERMIT <br />i <br />PERMIT f <br />— <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />FRONT SETBACK <br />U <br />REAR SETBACK <br />oZoI <br />SIDE SETBACK <br />S-r/d <br />PLAN bIECK UMBER <br />y <br />FEE <br />asG'S <br />RECEIPTNO. <br />9 37d3r <br />USE ZCN <br />LOTAREA <br />V ANT�1{, BITE <br />ES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />44323 <br />TYPE OF CCNST <br />ALLOWABLE/ADTUAI <br />� <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />✓ <br />_ _ <br />SIZE OF BLDG <br />ySlo <br />NO OF STORIES <br />' <br />BEAT <br />MM u T <br />OCC LOAD <br />MECHANICAL <br />/) Q <br />_ <br />OTHER <br />_ <br />FIRE SPRINKLERS REWIRED ❑ YES L� <br />HEIGHT LIMITATION <br />Ki <br />STATE BUILDING SURCHARGE <br />L A <br />APPLICATION ACC BY PLANS APPR BY _ <br />�-�) <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />c. <br />TOTAL <br />