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APPIJCATI64 FOR CONSTRUCTION PERMIT <br />the EHerjreeR evere[t <br />CITY ee <br />verett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PEASE PRh. <br />11 DEMOLITION I I COMBINATION I BUILDING MECHANICAL I I,iLUMBING I I SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />L w eQry G-313- t.,1 L;i 4'✓�" Vic, 3 r -3c 1V <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL MAILADDRESS CITY ZIP PHONE LICENSER <br />N'w- kill %i o, fh� 311D- d11u. Mt kdi lYzo] Z541-Oy MAW 13'7 K,1 <br />PLUMBINGCONTPA^.TOR MAIL ADDRESS CITY ZIP PHONE LICENSER ' <br />CLASS OF WORK <br />Ll NEW 1_1 ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT Ofl INTE,17 REPO PNLY <br />CONTRACT PRICE OF WORK: I CD OD <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGFJNVOVED <br />rLHsrAv1. (ins hE/11 <br />IROFgSED USE OF BUT NO <br />_ <br />I HEREBY 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 TI4E <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 ROW AND 296.200 WAG. <br />SIGNATURE /OOFF,C.OITRACTOR OR AUTHORIZED AGENT DATE <br />^ 11L. V' ti� <br />LEGAL DescAIPTION OF PROPERTY VIONiN BELOW OR ATTACH FOUR COPIES) <br />Lot BLOCK OF <br />— <br />PROJECT ADDRESS <br />' 3z , /C/ / ✓ • A L <br />L ( ,G <br />APPLICANTS CITY BUSMESS NSE 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 />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —A HNDLG UNITS—H.R <br />BATHTUB <br />' <br />_ <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 />I <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />D91NKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />-- <br />HEAT PUMP <br />� <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />+ <br />~— <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />I <br />1� <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />O <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR fETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />I I YES I I NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />i <br />TYPE O CGNST ALLOWABLE <br />TYPE OF CONST ACTUAL <br />G[LuvuLr <br />Lpp00 <br />II0010 LWI UAI$ <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />I I YES I I NO <br />MECHANICAL <br />OTHER <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D <br />I I YES I I NO <br />REASON FOR SPRINKLERS <br />HEIGIITLIMITATION <br />STATE BUILDING SURCHARGE <br />' <br />--�- <br />STA7EENERGY SURCHARGE <br />i <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />1� <br />