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APPLIG-ATION FOR CONSTFJCTION <br />PERMIT <br />the Evergreen rvpmil <br />CITY OF <br />everett nVcJ1\,, e <br />BUILDING DEPARTMENT <br />258.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />❑ NEW V ❑ ADDITION {-,6L_AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMOpTE-))L CO�NLY <br />` <br />CONTRACT PRICE OF WOOK 4�M f . (m <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE RKAND LIAREF IAGE INVOLVED <br />— <br />PROPOSED USE OFBUILXIDIINO LfL <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 GRANTINOOFA 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 1 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 18.21 RCW AND <br />296.200 WAC. <br />VONAI Ip.OF CO NI RA[TOn ORAUIHORIZEOAGENT DATE <br />X � <br />LEGAL DESCRIPTION OF Pp01•ERTYISHOWN BElOWO tIACH FOUR COPIEBI <br />LGT BLOCK__ OF <br />— <br />— <br />PROJECT AOORE99 <br />— <br />/ <br />A CANT CHY BURIN ICE Er AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — N.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— BIT.U.1114A EA <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS—BT.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP. <br />VENTILATION FAN _ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACES CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC 1 <br />SUBTOTAL <br />S <br />SUBTOTAL f <br />_ <br />PERMIT <br />E <br />PERMIT E <br />�_ <br />TOTAL FEE <br />S <br />TOTAL FEE f <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />D YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />OCCURLNCYOROUP <br />NO OF DWELLIRO UNITS <br />PLUMBING <br />_ <br />SIZE OF BLDO <br />NO OF STORIES <br />I BSM I. <br />o Y <br />Cl N <br />OCC LOAD <br />MECHANICAL <br />95 <br />ro^ <br />OTHER <br />_ <br />FIRE SPRINKLERS REQUIRED OYES DNO I <br />HEIGHT LIMITATION <br />ILDINGSURCHARGE <br />APPLICATION ACC BY PLANS Appn BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />