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H <br />aI3go <br />ty`�N <br />�H3W <br />PV FF-1'V <br />N F-1 <br />OE <br />H t7 <br />m0g <br />G99J Y CD <br />t'Iy� <br />FA r3 <br />g co <br />CA <br />oLiEn <br />HOEn <br />c <br />�. <br />v� <br />APPLICATION FOR CONSTRUCTICON4 PERMIT <br />(A: Ew'gw,, <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />i DEMOLITION ❑COMBINATION <br />'BUILDING MECHANICAL <br />OMER MAIL <br />DPECRY ZIP <br />P-vaiyCI�l �'� Vocrj g73c) e-w-G! yYagWNI <br />-1 <br />L'vl'rel l <br />PLUMBING SIGN <br />TENANT MAAADDRESS-'I CITY ZIP PHONE <br />del UVEX6tF MIDDfG -.%c cd- 7&ZI ay,Wt=ly U3 EYbRd'C 15203 <br />ARCHITECT OH DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />F10Ley Aswwrrecra, zRll Poop sT waw&Tr cigwl zse-6eti(_ <br />GENERALCONTRACTOR MAILADDRESS ^� •"' '^" <br />A]4)►ysP <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IT <br />CLASS OF WORK <br />NFw f-1 AnnITION ALTERATION ❑ REPAIR ❑ DEMOLITION LJ WOODSTOVE/FRPL INSERT X BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK: O'7r1 t'7PC <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />A'PP Q� Pa Lurrai ejAsSlohS <br />8°F <br />PROPOSED USE OF BUILDING <br />se-41yv L <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 LAVIS 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 1 HE <br />OWNER OF THIS PROPERI 'TO PERFORM THE WORK FCR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONT TOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOTBLOCK OF __ <br />--- <br />PROJECT ADDRESS <br />62 I�YER� UJ <br />G` <br />A 'LICANTS CITY B SINESS ENSE NO A USINESS 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—AIHNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />) __ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />I <br />— <br />I <br />I <br />SUBTOTAL <br />E <br />; <br />SUBTOTAL E <br />PERMIT <br />E <br />I <br />PERMIT E <br />_ <br />TOTAL FEE <br />E <br />' <br />TOTAL FEE E <br />_ <br />F HONT SETBACK <br />110 <br />REAP. SETBACK <br />U <br />SIDE SETBACK <br />PLANCHECK NUMBER <br />FEE <br />RFCEIPT NO. <br />IISE20NE <br />LOT AREA <br />E <br />I.7 NOBUILDING <br />FECS <br />VALUATION <br />FEE <br />• O dryTYPE <br />OF L'ONST ALLDNASI E <br />TYPE OF CONST. ACTUAL <br />PHEIGHTLIMITATIr <br />M)WMTLI'YIIAITS <br />_PLUMBINGFiIE <br />OF BLDG, <br />K (o <br />NO.OF SJORIES <br />1 <br />C.440OCCUPANCYLOAD <br />MECHANICAL-2(.s <br />OTTIER19 <br />FIRE SPRNKLERS REDO <br />�j ;- 4 o�. ! i YES C)?d0 <br />REASON FOR SPRINKLERS <br />AT <br />0 <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANSAPPROVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />j IF ' <br />u <br />