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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICP ION FOR CON$TRQTION <br />PERMIY <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />ARC HITECTO DESIONEP MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL AOORESS CITY ZIP PHONE LICENSE IT <br />MECHANICAL Cl/1nOOIN''ATT.R``ACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE IT <br />PLUM�rT'RAI oT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />Cl NEW ❑ ADDITION ❑ ALTERATION ❑ <br />❑ DEMOLITION ©`WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />wnIRAGI rwce v. avnn <br />DESCRIBE WORK ANp SQUnARE FOOTAGE INYOL O <br />PROPOSED USE Of BUILDING <br />1 c. <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 />ANYOTHERSTATE ORLOCAL LAWREOULATINGCONSTRUCTIONORTHE 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 WAG <br />IRONATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X f/o le, <br />LEGAL DESCRIPTION Of PROPERTY (SHOWN BELOW OR ATTACH FOUR COME 81 <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />c 7►r�! SIB <br />APPLICANTS CITY B SINERS LICE SEE AD AND BUSINE BS 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 />NC — A/HNDLG UNITS — N.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— BTU. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE — BAR ETC.) <br />SUBTOTAL <br />& <br />SUBTOTAL S <br />_ <br />PERMIT <br />& <br />PERMIT <br />TOTAL FEE <br />S <br />TOTAL FEE E <br />FRONT SETBACK <br />REARBETBACK <br />BIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />[OTAREA <br />VAEANI BITE <br />a YEB ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />_ <br />TYPE Of CONST <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGTOUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SUE OF BLDO <br />NO Of STORIES <br />ITSMI <br />a <br />ON <br />DEC LOAD <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SPRINKLERS REQUIRED OYES 0NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLICWORKS <br />TOTAL <br />