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APPLICATION FOR CONSTRUCT►jN PERMIT <br />Tn PI: rnUPI FTFn IN INK —PLEASE PRINT <br />CITYOF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />OWNER MAIL ADDRESS <br />HEATING SYSTEM: U GAS U ELECTRIC U <br />ever'll <br />e <br />BUILDING MECHANICAL PLUMBING SIGN <br />CI Y ZIP PHONE <br />Tk-, �3asi!46 Co P.O. <br />�oX ��67 lt/S aF-7G�Stol�7rC.C,(NA <br />J")zy <br />3E/L• 1/0- <br />TENANT MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />n co 11 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />TII-C A-05T-Ins CFI,.I1o1S <br />CITY ZIP <br />4'7-AVE A LVEtiGTI'JA.982Lx1 <br />PHONE <br />Z961-9/7-L- <br />GENERAICONTRACI0111 MIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />zz3 --T 1 A V 57 K- _371N1 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORN <br />I/ MEW AnnITInNI Al TFRATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT a BUILDING RELOCATION <br />CONTRACT PRICE OF WORN <br />CONTACT PERSON AND P\HONE NO <br />Ate/} /LY %E ZE'� �QS l� I 24• b — 56 3 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I/2G tU * -7 M A N rl F 4 C-7 <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 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. <br />SIGNATURE OF COWRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />PROTECT ADDRESS 0-3r <br />30,fq wr C 5i.✓U <br />APPLICANTS CITY BUSI 'SLICENSENOANDBUSINESSNAME <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 />AJC-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 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />_ <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />CAO nCCICF I lCF nNl V• <br />FRONT SFTBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />FEE <br />I RECEIPTNO <br />US@ ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUA,TIONEFEE <br />BUILDING <br />TYPE OE CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />ucanxtr <br />xa p Pmumc u,nl5 <br />cxou° <br />PLUMBING <br />SIZE OF BLOG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRNKlERS REO'D <br />IIEIGIIT LlMrtpilON <br />OTHER <br />_ <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PI(�pPpRVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />