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i <br /> APPLICATION FOR CONSTROCTION <br /> PERMIT <br /> the Evergreen <br /> CITY OF •I I•n41 <br /> everett <br /> BUILDING DEPARTMENT <br /> 289.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> OWNER 1 MAIL ADDRESS ZIP PHONE <br /> Jai . S1NA✓tr .Z10 -76 +-= S�•.�E+�• t✓en�� `►8x9-3 .3SJ•"lSIH <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> MECHANICAL CONTRACTOR MAIL ADDRESS /� CITY ZIP PHONE LICENSE• <br /> c✓IT9/I fA 5}ATT Shit+ mlAl, =A(. eo• Law )SDP E-.TQ f - gI).ZD4 WZn -?1)4 <br /> PLUM NO CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> CLASSOFWORK ---- ��- <br /> ❑ NEW & ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br /> I TENANT IMPROVEMENT OR INTER REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONTRACT PRICE OF WORK 30000 - <br /> DESCRIBEWORKANDSOUAREFOOTAOENVO.{LVVED e <br /> FA iA T TAC Ll aEn LtC�I1 <br /> N/: r <br /> PROPOSED(/+SE BAoUIL G I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> IPSI�1 TnCP KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEGAL DESCRIPTION OF PROPERIYIBNOWN BELOW OR ATTACH FOUR COPIES) 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 /> 1 LOT BLOCK__ _ OF ANYOTHER STATEOR 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 /> 288.200 WAG <br /> SIGNATURE OF CONTRACTOR ORAUTIIGRIZED AGENT DATE <br /> X �QfPFh( �p Lr-a <br /> PRCIECT ADDRESS AW <br /> AANTS CITY BUSINESS l NBE NO AND BUSINESS NAME <br /> ,210 '76 �' S1 .S .w, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET ITOILE'1 _ A/C—A/HNDLO UNITS—M.P. _ <br /> BATHTUB — --_ -� I FORCED AIR SYSTEMS—ST.U. MEA <br /> LAVATORY IWASH BASIN) UNIT HEATERS—BT.U. M •TrPoo — <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP. VENTILATION FAN <br /> DISHWASHER --_— — _ RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHESWASHER WDOD STOVE <br /> URINAL METAL FIREPLACE&CHIMNEY - <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING__- <br /> _ ROOF DRAINS—RAINLEADERS EXHAUSTFAN <br /> SINK(SERVICE—BAR,ETC)- <br /> SUB TOTAL <br /> TC)SUBTOTAL S SUBTOTAL 6 _ <br /> PERMIT S PERMIT _ S <br /> TOTAL FEE S TOTAL FEE 5 <br /> FRONTSETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br /> USEZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> O YES O NO <br /> TYPEOFCONST OCCUPANCYGROUP NO OF DWELUNGUNHS BUILDING <br /> ALLOWABLE/ACTUAL PLUMBING <br /> SIZE OF SEW NO OF STORIES SSMT. OCC LOAD <br /> D Y MECHANICAL _ <br /> ❑ N <br /> HEIGHT LIMITATION OTHER <br /> FIRE SPRINKLERS REWIRED O YES D NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> - -7 <br /> APPLICATION ACC By PLANS APPR Br <br /> PUBLIC WORKS <br /> TOTAL <br />