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APPLICATION FOR CONSTRUCI.ON PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />ii <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />DEMOLITION COMBINATION )< BUILDING MECHANICAL PLUMBING SIGN <br />OWNEfl MAIL ADDRESS CITY IiP PHONE <br />�oN �Roo�s 88�3'9�G�4�e5e. ,Evey0r 3S3- 72 ! <br />TENANT MAIL ADDRESS CRY /gypbg PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP 77 DD OOZP OO PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />—rom '3RoyK <br />s <br />;?722- /00 14156 <br />Eve. —ref <br />9g24;k1 33S-ry3(n B gooKT k,)/&okA4 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE I <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />:. NEW X ADDITION .. ALTERATION . REPAIR DEMOLITION WOODSTOVE/FRPL INSERT I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLys, <br />CONTRACT PRICE OF WORK:�"� <br />CONTnCT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />00 G <br />PROPOSED USEOF BUIL ING <br />STo R A Ge d G 4 R A G C <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEPTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZZCD./AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT JR BLOCK pso�Nr01F�IVV I(,' <br />PROJECT nADDRESS <br />/��.Y- Q9(S'E ✓~Lj LJ .�.�.J <br />G� <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FE <br />WATER CLOSET (TOILET) <br />AIC—AiHNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER X' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE jPtHIMNEY <br />' <br />DRINKING FOUNTAI <br />I <br />FIREPLACE INS <br />i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />_ <br />BACKFLOWYAEVENTERS <br />i <br />GAS PIPI <br />' <br />ROOF D INS—RAINLEADERS <br />I <br />EXHA FAN <br />I <br />IN <br />SERVICE—BAR, ETC.) <br />I <br />i <br />I <br />I <br />i <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT <br />$1 <br />PERMIT $ <br />I <br />TOTAL FEE <br />$1 <br />TOTAL FEE E <br />FRONTSETBACK <br />-20 <br />REAR SETBACK <br />101 <br />SIDE SETBACK <br />/ 3 <br />PLAN CHECK NUMBER <br />0 �vv�r <br />FEE <br />1Y..3s� <br />RECEIPT N O <br />33a2-8, <br />USE ZONE <br />�) <br />LOTAREA <br />DO <br />VACANT SITE <br />! , YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- -- <br />PLUMBING <br />5 <br />`� L; r <br />' <br />TYPE DF CONST ALLDWABI F <br />-u <br />TY Of CONST AP^AL <br />Q ,� <br />o6YMNOr <br />cAow <br />AO p vATtUNa M1n8 <br />SIZE OF BLDG <br />Sf Itai <br />NO OF STORIES <br />„-_ I <br />BASEMENT <br />YES NO <br />MECHANICAL <br />) <br />OTHER <br />i <br />OCCUPANCYLOAD FIRE SPRINKLERS REOD <br />YES X NO <br />REASON FOR SPRINKLERS <br />HECHT LIMITATION r �r <br />/�>OIE�T�_ <br />STATE BUILDING SURCHARGE <br />' <br />STATE ENERGY SURCHARGE <br />i <br />APPLICATION ACC BY <br />PLANS APPROVED BY <br />J�lf <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />