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APPLIC&4 TION FOR CONSTRkPCTION <br />PERMIT <br />The Evergreen <br />CITY OF I21 �' PVPmiI <br />everett <br />BUILDING DEPARTMENT <br />25P-9010 TO BE COMPLETED IN INK— PLEASE PRINT <br />i"Il71 <br />ENAN <br />airFLLTKI/.TTAO <br />'S <br />PONY�Z <br />L.u.✓A.'LUaoc> <br />gfjQ� <br />MAIL ADDRESS <br />CITY— <br />1!p ice` <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHONE <br />GENERAL LOP.TRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />UGENSEA, <br />I —I A IF•ET'7 <br />Wit.Ic.—ram....—_, — <br />.. / 1— — w_ <br />w — ._% <br />A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY LIP PRONE LICENSEE <br />_f-t IZTS PL u m B ti j f-A <br />CLASS OF WORK —� <br />SEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY (4909,29 <br />�J/ G CONTACTPER90N ANDPHONE NO <br />CONTRACI PRICE OF WORK 19 I /� M TILE M c 6,E.r�-F-A-E. Aw� <br />IZ�B QS K/ELU C`.�A9��-QUCTLO�L <br />P _J EDUSEOFBUILDOG <br />E F J'l N E 265/Dc,vc E <br />LEGAL DESCRIPTION OF PROPERTY ISeOWN ELOW OR ATTACH FOUR COPI[SI <br />LOT 3 BLDCK OFF 3 <br />PROJECT ADDRESS <br />q2 5 g 7,�'7H��T2FcT� rvk2Fr2_ <br />PLUS(BING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />—2—' WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_T SHOWER <br />J KITCHEN SINKS DISP, _ <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />SINK (SERVICE — BAR, ETC) <br />_ SUB TOTAL S <br />PERMIT _ _ S <br />TOTAL FEE _ $ E- _ <br />FRONT SETBACK REAR SETBACK —� SIDE SETBACK <br />sIT _ <br />USE ZONI LOT AREA ♦ VACANTSITE <br />_f 70/�/i9( YES ONO <br />TYPE OF CONST. OCCUPANCYOROUP NO OF DWELLINGUNIIS <br />ALLOWABLUACTUAL ' <br />Q•3 <br />SIZE OF B D6 NO. OF STORIES BSMT OCC LOAD <br />It(& Sr ❑Y <br />4CAt Ile J <br />HEIGHTLI I1�ATGN <br />FIRE SPRINKLERS REQUIRED OYES %&0 <br />APPLICATION ADC BY PLANS APPR BY <br />— `Lrfi <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 />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 r!AUE <br />AND I COMPLY WITH THE STATE CCNTRACTORS LAW 18.27 RCW AND <br />296.200 WAC () <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ALL-Lc1r'ST.DPU6c oPMOJN*f-,:ANr: <br />APPLIpANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEF. <br />A/C—A/HNDLG UNITS —H.P. _ <br />FORCED AIR SYSTEMS— BTU. M EA <br />UNIT HEATERS— ST.U. M <br />I CLOTHES DRYERS <br />VENTILATION FAN RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE A CHIMNEY -� <br />FIREPLACE INSERT <br />HEAT PUMP <br />OAS PIPING <br />EXHAUST FAN <br />SUB TOTAL S <br />PERMIT A <br />TOTAL FEE S <br />PLA CHECK NUMBER FEE RECEIPT NO. <br />_ FEES VALUATION FEE <br />BUILDING oye (/ S_Cl <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS 7 fj ^L+/ <br />TOTAL (r),3 -� 7 4 <br />