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APPLICATIO'►. FOR CONSTRU=T N PERMIT <br />everett C <br />TO BE COMPLETED IN INK —PLEASE PRINT l` <br />the Evergreen i <br />CITY OF I <br />everett HEATING SYSTEM: :)GAS AELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />[I DEMOLITION ❑COMBINATION <br />MECHANICAL ❑ PLUMBING L] SIGN <br />r <br />OWNER MAIL ADDRESS <br />MAIL <br />CLASS OF WORK <br />U NEW ❑ ADDITION <br />WORK AND <br />^ l <br />0 <br />LEGAL DESCRIPTION OF PROPI <br />LOT BLOCK <br />I.1 BUILD <br />CITY ZIP PHONE <br />CITY ZIP PHONE <br />CITY <br />PHONE <br />AOORESS <br />CI:Y ZIP <br />ADDR11E11S((S��I��''YY ��rYYY <br />CITY nrn **,,A�Y���� pQ`'�Q' �Y <br />AwAg REU71AJI0D A13 <br />_. TiIV1U��. If`T`. 2-��q-I_I,J <br />PHONE LICENSEmitS�G-3' <br />ZIP <br />ADDRESS <br />ALTERATION I. I REPAIR <br />I I DEMOLITION 11 WOCDSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTAO( PERSON AND PHONP N0. <br />INVOLVED <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />r---• (1 <br />I HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE OF <br />1G <br />PROVISIONS ELAWS AND ORMNANCES <br />,WWNN.BBELL+OW OR ATTACH FOUR COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />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 />OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />OWNER <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRADTORS LAW 18.27 RCW AND 296.200 WAD. <br />SIGNATUREe;R CONTRACTOR OR AUTHORIZED AGENT DATE <br />/ <br />T�C <br />/ <br />, C\ <br />/ APPLICANTS CITY fWSINESS LICENSE NO, AND BUSINESS NAME - <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_I <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />— <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />I ISE ZONE <br />LOTAREA <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACI <br />SIZE OF BLDG, <br />NO. OF STORIES <br />OCCUPANCY LOAD <br />FIRE SPFlNKLER: <br />INTAKE BY PLANS'APPR�OVED BY <br />TYPE OF EOI <br />A/C—A/HNDLG UNITS — <br />FORCED AIR SYSTEM; <br />UNIT HEATERS—B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & C <br />FIREPLACE INSERT <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />VACANT SITE <br />FEES <br />BUILDING <br />7,QUVA16y NO GF pN'lLI�XG UNIIG <br />G9W4 <br />PLUMBING <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIMITATION <br />_ <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />RECEIPT <br />