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CV1 <br />Aw <br />�A" <br />APPLICATII A <br />FOR CONSTRUCT ON <br />vf p 11 / <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />(Jl <br />OCT _ <br />HEATING GYSTEM: U GAS U ELECTRIC U <br />"""' <br />BUILDING DEPARTMENT <br />EV <br />Public ERE7r." <br />259-8810 <br />W <br />DEMOLITION <br />COMBINATION <br />BUILDING MECHANICAL <br />PLUift(PepF, SIGN <br />OWNEq <br />MAR ADDRESS <br />CITY ZIP PHONE <br />city of Everett <br />3002 Wetmore Ave Everett 98201 259-8700 <br />TENANT <br />MAR ADDRESS <br />CITY ZIP PHONE <br />Port Gardner Physical <br />Therapy <br />259-0239 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY LP PHONE <br />GENERAL CONTMCTOR <br />MAR ADDRESS <br />CITY ZIP PHONE <br />STATE LICENSE I <br />MEOHANIOALCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />STATE LICENSE A <br />Tenant <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CRY 21P PHONE <br />STATE LICENSE IF <br />CLASS OF WORK <br />A. <br />PECGIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTII PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK under 500 <br />DESCRIBE WORK AND SOUARE FOOTAGE MVOLVED <br />ductwork changes <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />clinic <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN UR <br />LEGAL DESCRIPTIONOF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIE5) <br />LOT BLOCK OF <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 />-- <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 />nn ll�� 7� q <br />l./'r , :tom' ' l "1 <br />- - - <br />SYWATIE DATE <br />PROJECT ADDRESS <br />,YEasrerss.IrnlsE Ho <br />3531 Rucker Ave <br />PI UMBING <br />MECHANICAL <br />IJO. <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 />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />ductwork changes <br />;UPTOTAL $ <br />SUBTOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />- <br />FRONT SETBACK <br />v,REAR SETBACK <br />SIDE SETBACK <br />PLAN CHI NU`MB,R <br />FEE <br />RECEIPT NO <br />7Y/ <br />USE ZONE <br />LOT AREA <br />VACANT 4TE <br />FEES <br />VALHATION <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLOWABLE <br />TYPE DE CONST. ACTUAL <br />p¢urAN;Y <br />NO aIffi'fuMC lmns <br />cxow <br />PLUMBING <br />SIZE OF BLDG. NO. OF STORIES BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />SPRINKLER <br />STATE BUILDING SURCHARGF <br />REASONFORSPRINKLERS <br />PUBLIC WORKS <br />INTAKE BYPUNS APPi1OVEE, BY CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�p - <br />7 <br />