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MR EvorBreon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269-8810 <br />APPLICr TION FOR CONSTRICTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />PINONE <br />GENERAL CONTRACTOR MAILADDRESS CITY .IP PHONE LICENSE <br />MECHANICAL CON T RACTOn MAIL ADDS ESS CITY ZIP PHONE LICENSE• <br />CLASS or WORK <br />❑ NEW ❑ ADDITION �_IA ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ 13UILDINGFIELOCATION <br />TENANT IMPROVEMENT OR INTEFS7,, REIAODEL ONLY CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK so J) <br />DESCRIBE WORKANn SOUARE FOOTAGE INVOLVED <br />�iaY-t. r C�c� Gl1 I�yi2K'S <br />� T'Q.1L7 r <br />PROPOSED USE OF BUILDING <br />-5�r 1--� <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAME TO BETRUEAND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTICN. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR on AUTTNORILED AGENT DATE <br />L�q [�1���—"� <br />APPLICAB Y USI ESE LI HNSE NO.A DBBSINESSN <br />LE9L_k5CRIFTION OF PROPERTY MOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK__ OF <br />PROJECT NDDRESS .p <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />ANC — A/IiNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />_ <br />UNIT HEIQERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& OISP, <br />_ <br />_ <br />VENTILA'ION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />PLATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />_ <br />URINAL <br />_ <br />METAL FIREPLACE& CHIMNEY <br />_ <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />_ <br />EXHAUSTFAN <br />_ <br />SINK (SERVICE — BAR, ETC) <br />_ <br />_ <br />SUBTOTAL <br />S <br />SUBTOTAL S_c <br />PERMIT <br />TOTAL FEE <br />S <br />$ <br />_ PERMIT 5 <br />TOTAL FEE S <br />L. <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT HO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES U NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLON'AGLE/ACTUAL <br />OCOUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLOO <br />NO. OF STORIES <br />BSMT. <br />❑ T <br />CN <br />OCO LOAD <br />MECHANICAL <br />— <br />/\I <br />o/ <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ No <br />HEIGHTLIMNATION <br />1 <br />STATE BUILDING SURCHARGE <br />APPLICATION ACL GBT _ PLANS APPR GV <br />\l�'I�Aryr 1V11 <br />STATE ENERGY SURCHARGE <br />PU BLIC VIORKS <br />TOTAL <br />