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APPLICP. riON FOR CONSTRUCTION <br /> PERM17 <br /> IAB Evergreen „. <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT -- <br /> 259.8810 TO BE COMPLETED IN INK— PLEASE PRINT — <br /> H <br /> MINER MAILADGPETS CI ZIP 1'HONF <br /> 9 1-3 (/1 TENAN—i MAIL ADDRESS COY .iilP PHONE <br /> H <br /> H ~ ARCHITECT OR DESIGNER MAIL ADDAESC CITY DP PHONE <br /> IC n <br /> H _ <br /> 0 = 0 <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> (n H <br /> H Z MECHANICALCONIRACIOR MAIL ADDRESS f CITY ZIP PHONE LICENSE• <br /> No <br /> C7 LoD�STA� Co `JET ►�, �g sT. f �`fi�_= -1�6C) LoAs+ t)4k�` <br /> PLUM&NG CONTRACTOR MAIL ADDRESS G1Y i ZIP NE LNiENBE• <br /> Hm8 <br /> Q. c) CLASS OF WORN <br /> z F-1 ❑ HEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVEJFRPL INSERT ❑ BUILDING RELOCATION <br /> aH — <br /> �t7' H y I LNANI IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERWN AND PHONE NO <br /> MICEOFINTORK <br /> DEWATEEAT IWORA AND BOUARE FOOTAGE INVOLVED DD C <br /> pICS I _ W)rrio L G MUG (4 rnit'LFs 546-I� $ <br /> "" m PROPOSED USE OF BUILDINGI HEREBY <br /> M,` ��9 L� KNOWTHE SAME O BE READ AND ALL PR VISIONSAPPLICATIONOF <br /> AND <br /> Z H En V�'LI–Il KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONSOF LAWS AND <br /> H O En ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> LEWLDESCRIP110N OF PROPERTY 19HOWN BELOW OR AIIACHFWRCORE81 WHETHER SPECIFIED HEREIN OR NOTTHE GRANTINGOFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> LOi FILOCN OF ANYOTHER 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 WIT TH STATE CONTRACTOR4 LAW 18.27 RCW AND <br /> 296,200 WAC <br /> SIGNATURE CO IR OR UDIORIZEDAGENT DATE <br /> _ X Q, <br /> 8 BULICENSPROJEDO9 APPIC BU&NF99 NA3M <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE CF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A:C–AHNDLG UNITS–H.R <br /> c z) BATHTUB rORCEO AIR SYSTEMS–RTU. M EA - <br /> IUNIT HEATERS–ST.U. M <br /> LAVATORVIWASH BASIN) <br /> SHOWER CLOTHES OR:ERS <br /> KITCHEN SINK 8 OISR VENTILATION FAN — <br /> DISHWASHER RANGEHOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE _ <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> iII__, DRINKING FOUNTAIN FIREPLACE INSERT <br /> `j FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS–RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE–BAR ETC) <br /> I 1Ae� __ I <br /> z <br /> SUBTOTAL S _ SUBTOTAL f <br /> PERMIT S _ PERMIT III <br /> (�u <br /> TOTAL FEE I TOTAL FEE S <br /> FRONTSETBACK REAR SETBACK SIDE SETBACK MAN once Nuumu FEE FECEIPF NO. <br /> USEZONE L07AREA VACANt SITE FEES VALUATION FEE <br /> n YES ❑No <br /> TYPE OF CONST OCCUPANCY GROUP NO Of DWELLING UNITS BUILDING <br /> ALLMABLEIACTDAL PLUMBING <br /> SIZE Of BLDG NO OF STORIES es�I Gcc LOAD MECHANICAL _ <br /> ❑N <br /> HEIGHT LIMITATION OTHER <br /> FIRE SPRINKLERS REQUIRED ❑YEB ONO I TATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APvcJnuGN Acc BY PLANS AIro1.er <br /> PUBLIC WORKS <br /> TOTAL <br /> n <br />