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APPLICATIOW FOR CONSTRUCTiJN PERMIT everett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett HEATINGSVSTEM: ❑GAS LECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION ,BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY 21P F IONE <br />Te, e. MAILADORESS / Y <br />TENANT CITY 21P PHONE <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP <br />Je <br />GENERALC TRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE LICENSEE _ <br />PH5�g 27s/ c�io59e/- <br />ti1� �/� lo✓s,' <br />MECMANICALCONTRACTOR <br />MAIL AODRE55 <br />CITY <br />ZIP <br />CENSER <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />11CRANI ITIFIKI <br />WMr)STOVE/FRPL <br />INSERT BUILDING RELOCATION <br />NtW uulllvry xnu.r.... .... .._. ..... <br />CONTACT PERSON AND PHONE NO <br />q <br />CONTRACT PRICE OF WORK CONTRACT <br />DESCRIBE WORK AND SQUARE FOOTA E Ii�ANVOLVED <br />n <br />l0i/.E r� U✓/OL � ✓ <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 />C!" <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PPOPERTY lSHOWN BELOW OR ATTACH FOUR COPIES) <br />BLJCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT <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. j.�� / <br />SIGNATURE OF CONTRACTOR O�R%AUTHORIZED AGE T DATE /L1 <br />'ce <br />X//11 <br />I~ /I <br />L/ y v/ SS'��'' <br />Al 'LICANTS CITY SINESS LICENSE NJA BUSINESS NAME <br />ADDRESS <br />PROJECTBU <br />/ <br />/✓✓ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EGUIPMENT FEE <br />WATER CLOSET (TOILET) <br />NC-AIHNDLG UNITS-H.P. <br />. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />LAVATORY TWA5H BASIN) <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />.LAUNDRY TRAY <br />WATER HEA1 ER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAIN:' -RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVI(,E-BAR, ETC.) <br />-- <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />rvrT VrrIVC VJC <br />FRONT SETRACK <br />VI\LI. <br />REAR SETBACK <br />SIDE SETBACK <br />.." . - <br />PLAN CHECK NUMBER <br />E <br />RECEIPT 0. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />/ <br />BUILDING <br />TYPE Of LONTS,AIIIOWABtE <br />-Z—Ai <br />TYPE Of CO�NSI ACTUAL <br />�lv <br />omaa.vcv <br />x0(XNIwvGurn5 <br />r <br />PLUMBING <br />MECHANICAL <br />1— <br />SIZE OF BLDG NO.OFSTORIES <br />746I �r_ 2 <br />OCCUPANCY LOAD FIRE <br />/SyPRNNLERLB�REO'D <br />�''/A�,,I IFI' �1 _ <br />REASON �FO�R �SP�R�INyKLERS L/AGWC-- 6 <br />f�/AL�T✓LT/"J �.�'/�j &—Xo <br />B SEMENT <br />lbel <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />E X' �6 Mr-?>rl <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS DLI or(l) <br />INTAKE BY <br />/I, <br />PLANS APPROVED BY <br />I , Z <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />'()� <br />