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S C 'O <br />as <br />ASH <br />>yT� <br />H zy zH <br />K az <br />0 m0 <br />�H� <br />y C' <br />rx-7 c n <br />ac <br />0�g <br />rii . 0 <br />H <br />r>" y z <br />Hy <br />CAI <br />gey <br />z rA <br />Z 0 FA <br />yON <br />APPLICATIG.4 FOR CONSTRUC7.JN PERMIT <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />'no Ew'grmn <br />CITY OF <br />everett �— <br />g� BUILDING DEPARTMENT <br />IAE 259-8810 <br />[J DEMOLITION COMBINATION <br />OWNER NAIL ADDRESS <br />HFATING SYSTElA: J GAS ❑ ELECTRIC J <br />BUILDING <br />❑ PLUMBING <br />(-scroll <br />e <br />1 SIGN <br />TENANT <br />MAIL ADDRESS <br />City <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MALL ADDRESS <br />CRy <br />ZIP <br />PHONE <br />DITY <br />ZIP <br />PHONE <br />LICENSES <br />GENERAL CONTRACTOR <br />MAh ADDRESS <br />CRY <br />ZIP <br />PHONE <br />LICENSE <br />I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />98aU� <br />'355 <br />3�� / 1La45,/i,.�G�c7�sel3 <br />l,1 l C� <br />!! t SE FL <br />iri,"rt: fe21/ <br />�� r <br />to <br />CITY / <br />ZU' <br />PONE <br />LICENSE <br />m I IMRnM COxTMLTOR <br />MAIL ADDRESS <br />r� ..e . m^k! I-i LMMIIATT)VFfFRPL INSERT BUILDING RELOCATION 1 <br />NEW.VAUUmoN AL I „�^••• -.• _—`----. <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />WORK <br />LEGAL DESCRIPTION OF PROPERTY ISIwwN BELOW OR ATTACH FOUR COPIES' <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <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 />A✓ ,�L..� <br />7Y}.A jt e3 n's -2no 0 <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />T' <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PROJECT ADDRESS nn <br />Ot%�' <br />APPLICAN ITV BUSINESS LICENSE IKI, ANDS WEBS NAME <br />MECHA ICAL <br />PLU <br />N0. <br />LNG <br />TYPE OF FIXTURE OR ITEM FEE <br />NO, TYPE OF EOUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A . <br />BATHTUB <br />_ <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />— <br />KITCHEN SINK B DISP <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />�— <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW-PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />FOR OFFIGt U,t <br />VPILT: <br />FEE <br />RECHPT NO. <br />fRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CIIECF UUMBER <br />3 !0 00 <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />BUILDING <br />TYPE Of CONTS. ALLOWABLE <br />TYPE Of CONSI ACTUAL <br />GcclmxcT <br />NB MOAl1LnIGUN,is <br />i <br />GR0°P <br />PLUMBING <br />I <br />MECHANICAL <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS REOD <br />HEKLHTLMITATKM <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />I <br />I <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />