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Me Evergree,I <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICACION FOR CONSTRI,vTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />RAC iy .4 1,2 T fLI /S_/s' InY7 S'&' � J+A eT1 9d.Ze3 %yS-S9 <br />6.Q <br />TENANT MAIL ADORERS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />1 <br />GENERAL CONTRACTOR MAIL ADDRESS GTY ZIP PHONE LICENSE• <br />/%1 tiY/ ��o t f eeT'e� � 0 R A /s90 /%,i/� ✓eTVA%L ttiA A'o dSORE �Ry 117AICe.rr 8S9AI <br />MECHANICAL CONiRAG10R MAIL ADDRE89 � CIIY ZIP P PHONE LICENSE <br />PLUMPROCONTRACIOR MAIL ADDRESS CITY ZIP PHONE LICENSE - <br />❑ NEW Cl ADDITION ❑ ALTERATION Jo 'REPAIR ❑ DEMOLITION ❑ W0009TOVE/FRPLINSERT_ ❑ BUILOINORELOCATION <br />DESCRIBE WORNANOBOUA E FOOTAGE INVOLVED <br />PROPOSED USE OF BURDING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINGOFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION ORTHE 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 WAC. <br />SIGNATURE OF CONTRACTOR UA AUTHORIZED ENT DATE <br />AP ��• LL/ �� Z` �''� 1N y — SI S __ <br />LEGAL EBCR LION OF PAOPERIYIBROW ELONOR ARACH TOUR CORE& <br />L eLocK of 9r7 <br />k <br />-s-,�--'— <br />PROJECT ADDRESS <br />S 7 <br />- <br />T s' 20 <br />_.— <br />APPLICANTS CII Y BUSINESS LICENSE NO AND BU5INE88 NAME <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 />_ _ <br />_ _ <br />A/C — A/HNDLG UNITS —H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS —ST.U. MEA <br />LAVATORY (WASH BASIM <br />UNIT HEATERS —ST.U. M <br />SHOWER <br />_ _ <br />_ _ <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK&DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />NEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL <br />S <br />_ -. SUBTOTAL III <br />_ PERMIT $ <br />IOIAL FEE & <br />PERMIT 6 <br />TOTAL FEE & <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK een <br />9 <br />FEE /� O <br />gUJi- <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACAFIT.SITf <br />Ll YES NO <br />I FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPE OF CONSI <br />ALLOWABLE/ACTUAL <br />SAY <br />OCCUMFICYGROUP <br />NO OF DWELLING UNITS <br />SIZE OF BLIG <br />NO OF;zay <br />% <br />BSMT <br />U Y <br />ON <br />OCC LOAD <br />N4- <br />OTHER <br />Fdawoo ♦ —_� <br />RITE BPRINKlER9 REWIRED OYES D <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />J <br />APPLICATION ACE; BY PLANSAPPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />�-7 <br />