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r.. 'Y.� <br />A r%r%o fn :it }BAsI Cf►A /+=Acorn. L'TIA1L1 <br />PERMIT <br />the Evergreen <br />CITY OF L verP1l <br />everett e <br />BUILDING DEPARTMENT <br />258.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />LIWNEq mAILAODRESS CITY ZIP PHONE <br />64�9T,UD27HWA -S-r s7 iN� 2721 111 r0i Ef � Ve(ZaTr' 9ezoB 337-7/s <br />TENANT MAIL ADDRESS OTT ZIP PHONE <br />ARCHIIECTORDESNINE MAIL ADDRESS CITY ZIP PHONE <br />OENERALCONIRACTOR MAILADDRESS OIY ZIP PHONE LICENSE. <br />S9mE <br />ECN MANICALCONIRACIOR MAIL ADOPT SS DIY ZIP PHONE LICENSE <br />PLUMBINOCONTRADOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OK INIERIOR REMODEL ONLY <br />CAN I RACT PLACE OF WORK' <br />CONTACT PEASON AND PHONE NO. <br />DE9CRIBEWORK ANO SOUAREFOOTAOEIN WED <br />-T�rw<<L ST1 /33� <br />PI1pPOSEO USE OF SURGING <br />$ r✓ q.•rTILY <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT At L PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIEDHEREINOR 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 CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />2982DO WAG <br />SIGNATURE OfCONTRACTOR ORAUIHORIZEDAGENT DATE <br />aP. a-zsr-�3 <br />LEGAL DESC IION UI PROPERTYI911OWN BELOW OR ATTACH FOUR COPIESI <br />o I CA ROL&-D <br />LOT BLOCK of ._ <br />C.2o�e VoL )N �F PlAT3.PA6L Ye <br />�r— <br />•� ,/ <br />_SNaNUrnISN COI/NIZ <br />PBCZECT AGGRESS <br />PLUMBING <br />APPLICANTS CITY BUSINESS LIPENSE NO. AND BUSINESS NAME <br />0 2• Z G t 14J� rFv7u✓ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIC— A/HNDLG UNITS— H.P. <br />2 <br />BATHTUB <br />i <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />2 <br />LAVATORY ASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK III DISP. <br />— <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />^ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE f CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />L. <br />ROOF DRAINS — RAINLEADERB <br />EXHAUST FAN <br />SINK(SERVICE— BAR. ETC.) <br />_ <br />_ <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />_ <br />TOTAL FEE f <br />TOTAL FEE f <br />FRONTSETRACK <br />2 0 <br />REAR SETBACK <br />2 0 <br />SIDE SETBACK <br />6 <br />PUN CN <br />CK NUMBER <br />a <br />FE <br />�5 <br />RECEIPT NO. <br />-75 <br />USEZONEE <br />LOT MEA1 / A O <br />V:rISIIENO <br />Er9ES O <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />4 O$ <br />TYPE OF CONST. <br />ALLOWABLE/= AL <br />OCCUFM/CYUROUP <br />NO Or OWELLING UNITS <br />PLUMBING <br />_ <br />SIZE OT eLOG. <br />3 3.- <br />NO. OF STORIES <br />' <br />B9MT. <br />� <br />MC LOAD <br />MECHANICAL <br />_LT <br />FIRE SPRINKLERS REWIRED OYES D <br />I IEIOHTLIMITAHON <br />OTHER <br />STATED ILDING SURCHARGE <br />APPLICATION ACG BY 71APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />toI/Ico <br />.. .. .. ._.. .I — .. . <br />