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the EvotgrlfR <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICATION FOR CONSTRJCTION <br />PERMIT <br />i <br />TO BE COME: ETED IN INK — PLEASE PRINT <br />ARCHITECT OR DESIGN ER MAILADORESS GIY ZIP PHONE <br />MAILADORESB <br />CITY ZIP PHONE <br />tICENSEA <br />GENERAL CGMIRAGION <br />MECHANICAL CONTRACTOR -- <br />MAIL ADDRESS <br />GTY ZIP PHONE <br />IIQNSEE <br />aMAIL <br />ADDRESS <br />GTV SIP MgNE <br />LICENSE• <br />NOCONIPI OR <br />�^„ V ^V ❑ ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />Cl NEW ❑ ADDITION ALTERATION <br />— <br />CANIACT PERSON AHDPNONE NO <br />1ENAN1IMPROvEMENTORINTERIGiREMODELONLY <br />CONTRACT PRICE Or WORK <br />----- -- <br />OE/ISCmat WORK AND UAR FqqTAOE IN VCD <br />rao _DU o WILDING <br />F' <br />IHILRE:.9Y CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW7HE SAME i0 BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />J-c- ICE <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED H EREIN OR NOT. THE GRANT I NO OF A PE RMIT DOES NOT <br />LEGAL DESCRIPTION Or PROPERFr(SHOWN BELOW' OHA"ACH FOURCOPIESI <br />PRESUME i O GIVE AUTHORITY TO VIOLATE OR CANCEI_ THE PROVISIONS OF <br />OF <br />— <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />LOT BLOCK_._ <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />FOR <br />THIS IS MADE <br />PI RCOMPLYOPEPPf TWITHRFORM THE <br />THE STATEWORK <br />AND CONTRACT+ORSHLAWLICI18270NRCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRACTOR OR AGO ICRIZE D ADEN T DATE <br />X <br />PROJECT A06 ESS <br />APPLICANTS CITY BWINESitiCENSENO ANUBUSINESSNAME <br />L <br />PLUMBING <br />MECHANICAL <br />NO. _ TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OP FIXTURE OR ITEM <br />FEE <br />WATER CLOSET(TOILET) <br />NC—A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS —ST.U. MEA <br />_ <br />BATHTUB <br />UNIT HEATERS —flT.U. M <br />LAVATORY (WASH BASIM <br />T.LOTHES DRYERS <br />SHOWER <br />KITCHEN SINK DISP. <br />VE;!TII_nTION FAN <br />DISHWASHER <br />RANGE H000 <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACES CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INsjnT <br />FLOOR DRAIN <br />HEAT PUMP <br />SACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL <br />3 <br />SUBTOTAL S <br />PERMIT <br />f <br />PERMIT • <br />TOTAL FEE <br />>i <br />TOTAL <br />FEE s <br />FRONT BEIBACK RM SETBACK <br />SIDE SETBACK <br />PUINCHlLK MUMefe <br />FEE RECUR NO. <br />USE ZONE <br />TOY EEA <br />VOA ANSTBIIENO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />_ <br />TYPE Of GGNBr <br />OCCUPANCY GITOUP— <br />NO. Of DWELLIND UNIIB <br />ALLOWABLEJACIUAt <br />PLUMBING <br />SIZE OF FL <br />NO OF STORIES <br />BSMr. <br />ClyMECHANICAL <br />DLC•ADD <br />OTHER <br />ON <br />HEg11f lIMOA1pN <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERSREWIREO OYES ONO <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICAVONACCW PLANS APPII. BY <br />TOTAL <br />