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APPLICi,stiON FOR CONSTRI.a:TION <br />PERMIT <br />The EvorOroon <br />erett <br />CITY OF 10 <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TENANT <br />TENANT MAIL AUDRE 50\ (HpOITV ZIP PHONE <br />CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />GENERAL <br />�� ���� <br />-SM rasT E' \Y_k <br />QA\�.T <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY q�ZIAe� PHONE LICENSE• <br />. ('2 N=I L-1 ,t.A1.]F 'C\E 4�o"DTrlY.lil.F 11 `1tnz-e�-t4L a1,16�S L1�'Zaat <br />CLASS OF WORK <br />fl fl CPAIn M nPMni ITION ❑ WOOOSTOVEJFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />, <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND"■T <br />KNOW THE SAME TO BE TRUE AND 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 />ANYOTHER STATE- OR LOCAL LAWREGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />286WAC. /\a/✓ \ <br />SIGNATURATUR E OF CONL CTOIiOR 0.Ulp DATE 'A <br />LEGAL DESCRIPTION OF PROPERTYISMOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />- <br />PPOJECT ADDRESS <br />7Gol Eves i <br />5 c P pz <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING Y <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />I <br />A/C — AHNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —B.T.0 M <br />_ <br />�— <br />SHOWER <br />Zt) <br />CLOTHES DRYERS <br />— <br />KITCHEN SINK& DISP. <br />_ <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />_ <br />'� <br />WATER HEATER <br />j_,3- <br />rrri <br />CLOTHES WASHER <br />WOOD STOVE <br />— <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />— <br />�_ <br />DRINKING FOUNTAIN <br />INSERT <br />(� <br />=LOOR DRAIN <br />_FIREPLACE <br />HEAT PUMP <br />— <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />— <br />ROOF DRAINS— RAINLEADERS <br />_ <br />_ <br />EXHAUST FAN <br />— <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />$ <br />IS <br />—�G� <br />SUBTOTAL $ <br />PERMIT 3 <br />�3— <br />_LS_ <br />pQ_ <br />TOTAL FEE <br />$ <br />irr <br />TOTAL FEE $ <br />co <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETWCK <br />PLAN CHECK NUMEER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />O YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLUACTUAL <br />OCCUPANCVGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />- <br />SIZE OF BL00 <br />NO OF STOPCi <br />BSMT. <br />O Y <br />O N <br />OCC LOAD <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PIANSAPPR. GY <br />STATE ENERGY SURCHARGE <br />— <br />PUBLIC WORKS <br />- <br />TOTAL <br />Z� <br />_ <br />