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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLICs.TION FOR CONSTRICTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADOP ESS CRY ZIP PHONE <br />i�nHONHp I-RAw1aLl /4DLDEtJ .10.1, , �1 JT• S6 iFae I, f ?/1A3 .i.r•r-1. L o I <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />I00H'IM JOJAYM RL10. <br />L70NhAJ4-u�-l3lkh <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />N0R1(A %OU-To ocTo, <br />/NHYk (PAtks,rdt,r <br />Qa✓I, <br />aays✓tl-<-lot )D <br />6 r3 -ZrtL <br />MECHANICAL CONTRACTOR <br />MAIL ADORF. F9 <br />CITY <br />ZIP <br />PHONE LICENSE <br />.,UMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW gl-(ADDITION B"ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRP. INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK �] 10 OJ 00 <br />CONTACT PERSON AND PHONE NO-. <br />�� �L)" <br />yDESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />/00r ROILI, IF.1 -4WI Mo FL YIM r- iI^/p RIY <br />PROPOSED USE OF BUILDING <br />F-•/JIl TIND t./OJ/i-r <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 HEREINOR 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 I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296 200 WAG p i <br />SIGNATURE OF CONTRACTM OR AUTHORIZED AGENT DAtEAZL /0//T O / <br />X IE NDI-1L 3JJA�r al0 1 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPES) <br />L 3 it A. r,L t <br />Lot eLocK�—OF N&/4Lh//' Qla- �• <br />A.'1 AA.. w <br />-- <br />PROJECT ADDRESS <br />I E✓F <br />APPLICANTS CITY BU IN SS IICENSE 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 -NHNDLG UNITS -H.P. <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS - B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK A DISP. <br />_ <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOODSTOVE <br />_ <br />URINAL <br />METAL FIREPLACE 3 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAI NLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE - BAR, ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL S. <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTAL FEE <br />5 <br />TOTAL FEE S <br />FRONT SETBACK ' <br />—�O <br />REAR SETBACK <br />SIDE SETBACK ACK <br />-__- <br />PLAN CHECK MBER <br />92 <br />FEE 2� <br />RECEIPT NO. <br />USEZONE <br />2!/1 <br />i/••_ <br />LOT AREA <br />VACANT SITE <br />tl YES 1160 <br />FE9 <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONS' <br />ALLOWAeLEdC1UAl <br />SIZE OF BLDG-iYTc -� <br />OCCUPANCYGROUP <br />n_-3 <br />NO OF STORIES BSMT <br />n Y <br />NO OF DWELLINGUNITS <br />/ <br />OCC LOAD <br />PLUMBING <br />MECHANICAL <br />OTHER <br />I- <br />FIRE SPRINKLERS REOUIPED fI YES o <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />1 <br />APPLICAIIONACC BY PLANS APPR BY <br />N(� <br />' 11 rn (, .) <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />— <br />TOTAL <br />�� <br />