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MPPLICA-dON FOR CONSTRU,4;TION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />EUILUING DEPARTMENT <br />259-8810 <br />• DW NER ��], <br />TENANT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />MAIL AODRE" CRY ZIP <br />330 -�atiu S i laviceerr w <br />MAIL ADDRESS CRY zip <br />'3'3 o - 7?r "a s"r' C-L�earr 4 <br />MAILADDRESS CITY ZIP <br />sows (00A- Ico IUrq bu1� r1prL.I,. <br />53,07 <br />sad <br />u I?<-- <br />NI li' - <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENTORINIERIO EMODELONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERAON Ann MIONE NO <br />DESCRIBE WORK ANDSGUARE FOOTAGE INVOLVED <br />LAT415 <br />♦ •/ I1 I I�IF <br />L/F�MX <br />Prq EDUSE OF BUILDING <br />REFL'rOUEfi�L <br />POi'r <br />IHEREBYCERTIFY TMATIHAVE 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 OF A 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 CONSI RUCTION THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM fHE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCN' AND <br />WAC, <br />BIONAfU0E0 CONTRACTOR OP AU DI RIZEO ENT DATE <br />SIGNATURE <br />X <br />erPUCA4.1111UR, (.SSIICF NSENO ANDR 41NE59NAME�c-7� <br />Scsc �' <br />LEONE DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR CORES) <br />LOT BLOCK OF <br />/��.y.cr� <br />f]C,i^CYY•U2�• PR-�^�-•�-••�1�( <br />• I ✓a�-7� <br />F I rr�� <br />ITOd•D—DOO'�CJ�� '-OQO � <br />PROJECT ADDRESS / <br />�r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CG JSET ITOILET) <br />NC-A/HNDLG UNITS -H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS - S.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -ELT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKII DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />EIACKFLOW PREVENTERS <br />DAB PIPING <br />_ <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR. ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />_ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />_ <br />TOTAL FEE t <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFIT <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />I] YES IT NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST <br />ALLOWABLE/ACTUAL <br />CCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />_ <br />SIZE OF BLDG <br />NO OF STORIES <br />RENT, <br />D V <br />❑ N <br />OCC LOAD <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SRONKLERSFIEOUIRED DYES D NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATIONACCBY KANSW Rr <br />STATE ENERGY SURCHARGE <br />PU6LK. W'011 ITS <br />TOTAS <br />�EI�IrB1 <br />