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I <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-SS10 <br />APPUGo-*TION FOR CONSTRUCTION <br />PERMIT <br />1'VI'f PII ' <br />e <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />-w4.E E fArAeF•?T _ %��a3 363-72oJ <br />E99 GHT 21P PHONE <br />/'l0 /V/P <br />AfIGNRFCT OR DESgNER MAILADDRESS CITY ZIP PHONE <br />No Ne <br />GENERAL CONTRACTOR �7 n MAIL ADDRESS CITY ZIP PHONE QCENSE <br />91 <br />z03 �Z;2-s%2_ DwrnAGl2e3 <br />PLUM�CONTRACTOR • MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NO <br />/�o N P <br />CLASS OF WORK <br />-. r-I ___. _.. I--1 ..___-_._.. �Pi ......�.. I'l w r,114T IFAPI. INSERT ❑ BUILDING RELOCATION <br />u nc <br />TENANT IMPROVEMENT OR INTERgq REMODEL ONLY <br />CONTACT PERSON AND P�HDNE NO <br />NL' �J �OO <br />� <br />�r 19'9Q_ /A6/t C <br />!ClONTRACT <br />PRICE CY WORK: <br />DESCRIBE WORK AND SOUARE FOOTAGEINVOLVED <br />IV Fio tJ <br />PTI 9ED USE OF BUILDING <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 />P ro <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WIT: I <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />l OAL DESCRIPTION Oi PROPERTY ISHOWN BELOW OR ApACN FOUR COPIESI <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT BLOCK 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 MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296,200 WAG <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AlE L DATE <br />PROJECT ADDRESS <br />APPOCANTSCH BUST SSLI NSE NO AND SU55INESS NAME <br />-� - F <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC - A/HNDLG UNITS - H.P. <br />FORCED AIR SYSTEMS- BT.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE S CHIMNEY <br />— <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />SACKFLOW PREVENTERS <br />OAS PIPING <br />_ <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR, ETC) <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT _. $ <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />ON ?SETBACK PEAR SETBACK <br />SIDE SETBACK <br />MANCHECKNUMBER PER RECEIPT NO. <br />WFTONE <br />LOT AREA <br />VAUNT SRE <br />FEES <br />VALUATION <br />FEE <br />!- <br />DYES U NO <br />BUILDING <br />TYPEOFCONST. <br />OCCUPANCY GROUP <br />NO OF OWElLINO UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLDG <br />NO OF SIORIEB <br />B51AT. <br />OCC LOAD <br />MECHANICAL <br />— <br />or <br />OTHER <br />ON <br />NEgHT (IMITATION <br />STATE BUILDING SURCHARGE <br />FI4E SPRINKLERS REOUIRED DYES U NO <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICATION ACC BY PLANS AM BY <br />TOTAL <br />I <br />