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the Evorgrean <br />CI)Y OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />••I! 1 <br />APPLICAliON FOR CONSTRULTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />0 <br />Everett <br />I. <br />r <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />LICENSER <br />PHONEEp��/� <br />' <br />z�55m115� LS <br />MECHANICALCONTRACTOR MAILADDRESS CITY ZIP <br />PHONE LICENSE• <br />as'l9 15� f��11%� �GDm4np <br />?D�`d a0y3 <br />PLUM SING CONTRACTOR MA.ILADDnESS CITY ZIP <br />PHONE LICENSER <br />❑ NEW ❑ ADDITION J4 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVErFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT US INTER) RREMODELONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO, <br />DESCRIBE WORN AND BOUARE FOOTAGE INVOLVED <br />A �d � l�.aA�. <br />PROPOSED USE OF BUILDING <br />E>( q <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAMETO BE TRUEAND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING PHIS TYPE OF WORK WILL BE COMPLETED WITH <br />WH ETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUM E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORE( FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH T:IE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.2CO WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTIONOF PROPERTYISSHOWN BELOy.W1A4TTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECTADDRESS <br />cD l ter_ f <br />APPLICANTS CI B INE'S LICENSE NO. AND BUSINESS N E�^ <br />PLLUMUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />A/C — A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />_ <br />UNIT HEATERS— B.T.U. M <br />_ <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK& DISP. <br />_ <br />_ <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />_ <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />_ <br />_ <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />_ <br />ROOF DRA114S — RAI NLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />3 <br />PERMIT S <br />_ <br />_ <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMPFR <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />1YPEOFCONST. <br />ALLOWABLEIACTUAL <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES I BSML <br />❑ Y <br />ON <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />_ <br />FIRE SPRINKLERS REQUIRED OYES ❑NO <br />HEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. OY <br />-- <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />