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APPU%=ION FOR CONS1 r411CTION <br /> PERMIT <br /> the Evergreen <br /> CITY OF evelett ! <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEREU11nMAIL ADDRESS CITY IIP PHONE <br /> IJT�R1l1 121 lcit-h PI sr E V gCizn'S 35 3 X73 <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> u <br /> ARCHITECT OR DE SIGN ER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> MECNA LONT AC R MAIL ADDRESS CRY IIP PHONE LICENSE• <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> CIABB OF WORT( I <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONTRACT PRIDE OF WORK L�'I <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> IL1Pu� ,fW,' �S o _ <br /> PROPosEO usE of Bu1LD1NG� I HEREBY CERTIFY THAI I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> C((tr PDl A�� KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF AWS AND <br /> LEGAL DESCRIPTION Oi PAOPERIYIBIIOWN BELOW OR ATTACH FOUR COPIE ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WHETHERSPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> LOT BLOCK OF —,�C.��g+rTL- ' .� HERSTATEME TOOR LOCAL AW REGULATING CO STRUCTION OR IVE AUTHORITY TO VIOLATE OR CANCEL THE THE PER- <br /> FORMANCE <br /> FIONS ORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APF:'CATION IS .MADE <br /> AND 1 COMPLY WITH THE STATE CONTRACTORS LGY 1L 17 RCW AND <br /> 298.200 WAC. <br /> SIGNATUREOF CONTRACTOAOR AUTHORIZED AGENT DATE <br /> X ' <br /> PROJECT ADDRESSa) qq 1 A LIC 1 I BU SULEN8E N0 BUSMEBB NAME <br /> 4Vh' pi <br /> PLUMBING MECHANICAL ' <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE 4. <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. k <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. MEA <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> — I <br /> CLOTHES WASHER WOOD STOVE — <br /> URINAL METAL FIREPLACE CHIMNEY l <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP �. <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR ETC) — <br /> I <br /> 1 <br /> I" <br /> SUBTOTAL i SUBTOTAL i <br /> PERMIT i PERMIT i 'I <br /> TOTAL FEE i TOTAL FEE i 1 <br /> FRONT SETBACK REAR BETBACK 51DE SETBACK PLAN CHECK NUMBER FEE 111091"No. Ir <br /> F aa'c #0 c ' 295 a 93o <br /> USE IONS LDTAREA VACANT BIr FEES VALUATION FEE <br /> 5—w ❑YES pNO <br /> IrZk 00 <br /> TYPE OF CONST OCCUPANLYGAOUP NO OF DWELLING UNITS BUILDING <br /> ALLOWABVfUZAL �j{,� PLUMBING _ <br /> SIZEOFSLDG NO OFSTORIES BSMT OCC LOAD <br /> n Y MECHANICAL i <br /> S.F. `LN MIA <br /> rC I: <br /> HEIGHT LIMHAJION OTHER Y <br /> FIRE SPRINKLERS REGUIREO OYES (NO , STATE BUILDING SURCHARGE 4 S <br /> STATE ENERGY SURCHARGE <br /> APPLICATION ACC BY _ PIANS APPA BY <br /> PUBLIC WORKS <br /> TOTAL <br />