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the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICATION FOR CONSTR%JCTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />DINNER MAILADDRESS 1'11 ." I^"vl <br />Jim Halvorson 1731 74th St EvereLL 98203 353-4521 <br />TENANT MAIL ADORE SS City ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CITY <br />ZIP <br />PHONE LICENSE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />Everett Bldrs. Inc. <br />5606 Evergreen Way <br />Everett <br />98203 <br />353-7161 EMEB*301PH <br />MECHANICAL CONTRACTOR <br />MAILADOREW <br />CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION IN REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL.INSERT ❑ BUILDINORELOCA1II0N <br />TENANT IMPROVEMENt OR INTERIOR REMODEL ONLY QORTACI PERSON AND M10NE NONO <br />9.14R'1_oo Dan Mann (353-7161) <br />DESCRIBE WORK AND BOUME FOOTAGE INVOLVED <br />Recover existing roof and <br />install gutters <br />PROPOSED USE OF BUILDING <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 />WHETHERSPECIFIED HEREIN OR NOT.THE GRAN FINGOFA 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 />29e.200 WAC <br />RIONMURE OF NIRACIOn OR ALL 14DRIZED AGENT DIME <br />APPLK:ANTP CII BI be ICEN A 0 v� <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW On ATTACH FOUn COPIEbI <br />LOT- BLOCK OF <br />_ <br />PROJECT ADDRESS <br />1731 h SLreet Everett, <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />CLOSET (TOILET) <br />AIC — AIHNDLG UNITS — H.P. <br />. <br />_ <br />_WATER <br />BATHTUB <br />FORCED AIR SYSTEMS— RT.U. M EA <br />_ <br />LAVATORY IWASH BASIN) <br />UNIT HEATERS — EMU. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />_ <br />_ <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <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 />SUB TOTAL <br />& <br />SUB TOTAL _ & <br />_ <br />PERMIT <br />S <br />_ _ PERMIT - _ & <br />TOTAL FEE $ <br />_ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />a YES CT NO <br />-DWELLING <br />_AG <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />L <br />�— <br />TYPE OFCONST <br />ALLOWABLEIACTUAL <br />OCCUPANCYGAOUP <br />OF UNITS <br />�- <br />SIZE OP $LOG <br />NO ZF STOTIIES <br />B.SM I. <br />G v <br />OCC LOAD <br />_ <br />FIRE SPRINKLERS BEOUIOEO LIVES ❑ No <br />I <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />