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APPLIC �(ION FOR CONSTR6,CTION <br />PERMIT <br />BID Evprgrppn <br />CITY OF evcrett <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />/OWNER MAIL ADDRESS CITY ( ZIP PHONE <br />ef�_�V�l'Y'M )!I .5�1/�C_G1 >+C2 GY'�✓'C/ / <br />v TENANT MAIL ABONUS CITY 21P PHONE <br />ARCHITECT OR DESIGNER_/ MA;L ADDRESS CITY ZIP PHONE <br />&cl Y"/ /� Con fT . _ <br />GENERAL CONTRACTOR MAIL ADDRESS // CITY ZIP PHONE LICENSE. <br />�YQISSWoc�l' ct� .29'9r, V%97«-.2 <br />IN <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />❑ NEW Cl ADDITION ❑ ALTERAT.ON ,N REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT Cl BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACTPERSONANDPHONENO <br />OESCflIB:- RKAN1SQUAREFCOTTAGEINNVOLVE/D <br />�YTI c/ !w )Orly 'y-�-/,���_JSC-tps <br />I I IEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING IRIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED H EREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />PRESUME 10 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE' VORK 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 R ROR AUTHOF' D GENT PATE <br />PROPO E OFBUILDING . <br />, J oil <br />LEGAL ESCRIPTIDN OF PROPERTYTSHOWN UELOWOR ATTACH FOUR COPIES) <br />LO7 BLOCK— of <br />PROJECTADDRESS <br />DI T <br />- <br />On GI LESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />_WATER CLOSET (TOILLT) <br />A/C— A/H N DLG UNITS — H. P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS — STILL M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPIN^_ <br />_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK(SERVICE — BAR, ETC.) <br />_ <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT 5 <br />TOTAL FEE S <br />TOTAL FEE $ <br />_ <br />FRONTSETBACK <br />REARSETDACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST, <br />ALLOWABLEMCTUAL <br />0 CUPANCYGROUP <br />TIO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BSMT. <br />❑ Y <br />DN <br />OCL LOAD <br />MECHANICAL <br />- � <br />l <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑YES 0ND <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATO Y PLANSAPPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />ai <br />I <br />9 <br />