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APPLICATIO A FOR CONSTRUCT, )N PERMIT CV�fL'I1 <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett BUILDING DEPARTMENT HEATING SYSTEM: - GAS LECTRIC 1-1 <br />- <br />259-8810 If <br />DEMOLITION COMBINATION BUILDING AECHANICAL PLUMBING SIGN <br />• \ PER MAIL ADDRESS cievi FI vfzIP PHONE <br />z5T �ar�y <br />— IA�98iL� <br />Z,�L <br />TENANT <br />FiP�ii �rJT <br />MAIL ADDRESS <br />T4 <br />Aal.Lvl 1�f CJJ�y,�p <br />iiu��s.G AJ Rif u�'_ <br />ZIP <br />9r3w � <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP r <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />ITY�}�. <br />Ir <br />`HONE <br />IyJE•CH.ANNIICALONTRAC�TO{R..-��MIAILA/DDRES'S/ <br />C/,, �LFI�G�ENjSE�•�AL lrA <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CIT <br />- DP <br />PHONE LICENSE) <br />ZCLOF WORK <br />EW ADDITION TERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />, n <br />CONTRACT PRICE OF WORK ` {„{[ <br />mx <br />�/T OgE, <br />'Ally <br />CONTACT PERSON AND P�jIONE NO. p <br />DESCRIBE WORK AND SOUAWE FOOTAGE IN LVED <br />PRO SED USED B ILDING <br />(qA <br />EREBY CERTIFY THAT I 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 PROPERTY 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 />ATU OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />` <br />)APICA <br />LEGATEES RIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK OF <br />PR EC ADDR SS <br />It ln� <br />L <br />T ITY BUSINESS IIC S NO. AND B NESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & 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 & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />f <br />SUBTOTAL <br />$1 <br />SUB TOTAL $ <br />PERMIT <br />$I <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />I VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF CENTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />XCUPANp <br />0 P <br />xo aaenLINGUNTS <br />SIZE OF BLDG <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO 0 HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />�— <br />INTAKE BY <br />PLANS APPROVED BY <br />�y J <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />