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APPLICATION FOR CONSTRWTION <br />PERMIT <br />LAB Evergreen ie <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADDRESS J CITY ZIP PHONE <br />sTA/m S Ou�'ANO 25t a — C ; " 5 r Fvd54ar7 Fr,6;z 03 3'// — `&07 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CNY ZIP PHONE <br />,ofelle, e CCe57VM Oe Oa `-4 ? N /jam ve sKT r6y setfffrc ger33 34 zs'o :?S <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />AtPiN6 cc4srds BLOC 172,7 N fRo wire?yEwnee' 98F/33 34z���s,IciicrB�s�iy <br />MECHANICAL CONTRACTOR MAIL ADURESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />4;'R'UF rl AnnLTICIN ❑ AITFRATIDN ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOV&FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY 1' E/ A L Ka A"CANIALT <br />CONTRACT PRICE OF WORK tl n N�� /� <br />PERSON AND PH ONO <br />.� 've Zero gz <br />j8 EN % Z /yNEL�ytrm e E �/ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />r,cNSrm(a V-r NEW 5c, S f 0,40e <br />PROPOSED UBE DF BUILDING <br />GA,fW646. <br />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 />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 />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 />S-dNATUAE 01 CONIROB ACIOR ALIPHORIZED AGENT DATE <br />X <br />~ <br />0- gc2— <br />LEGAL DESCRIPTIONOF PROPERttIeHOWN BELOW OR ATTACH FOUR COPIEN <br />LOT BLOCK OF <br />PROJECT ADORES9 <br />;z2og — (g �.,, Sc <br />C v�.PE!T <br />APPIiCA SCIIY USIN 'SLICE( NO AND BUSIN UME <br />v;ta? tP"JvC ct-sro&q <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 -NHNDLG UNITS -H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS -BT.U. MEA <br />LAVATORY (WASH BASIN <br />UNIT HEATERS-BT.U. M <br />SHOWER <br />CLOT14ES DRYERS <br />KITCHEN SINK& D1SP. <br />_ <br />VENTILATION FAN <br />_ <br />_ <br />DISHWASHER <br />_ <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />_ <br />ROOF DRAINS - RAINLEADERS <br />_ <br />EXHAUS_TFAN _ <br />— <br />SINK (SERVICE -BAR, ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL i <br />_ <br />PERMIT <br />S <br />PERMIT $ <br />_ <br />TOTAL FEE <br />S <br />TOTAL FEE f <br />FRONT SETBACK / <br />REAR BETMCCK/ <br />SIPE RETBAC <br />PLAN CHECK UMBER <br />a5 <br />F[C <br />�( <br />RECEIPT NO. <br />a33a7 <br />uezzo <br />—� <br />IOTAREA <br />VACANT SITE <br />O YES �NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/^ <br />ttPEM CONST. <br />ALLOWABIE/ACTUAL j� • , <br />`�•� N <br />OCCUPANUOP <br />M _ I <br />NO Of DWELLING UNITS <br />PLUMBING <br />—�— <br />BIZEOF BLDO <br />3o re Sir <br />NO OF STORIES <br />' <br />BSMT. <br />❑,Y <br />N <br />MCLOAD <br />N A <br />^T <br />MECHANICAL <br />OTHER <br />_ <br />FIRE SPRINKLERS REWIRED OYES 0 <br />HEIGINLIMNAILON <br />15-Y <br />$TATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANE APPR BY <br />STATE ENERGY PURCHARGE <br />PUBLICWORKS <br />TOTAL <br />n <br />1 <br />