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APPLICATI.JN FOR CONSTRUC► AON PERMIT everett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett �-- <br />BUILDING DEPARTMENT <br />259.8810 <br />1 1 DEMOLITION I I COMBINATION <br />OWNER MAIL ADDRESS <br />k1+ ,":� n„o 0 3us�. <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I I BUILDING MECHANICAL <br />CITY ZIP _ Pk <br />BING I I SIGN <br />NE LICENSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHO <br />21P PHONE LICENSE <br />MECHANICAL CONTLACTOR MAIL ADDRESS CITY <br />a, n � 'Ic fIL- %9 IS�GDmonci <br />\1�C1�J5(�e�P'fl5 CITY Zlp PHONE 1 LICENSE �T <br />PLUMBINGCONTRACTOR MAIL ADDRESS �tiViC �g� aoy3 (?��Sml I L_S <br />CLASS OF WORK /FRPL INSERT Cl BUILDING RELOCATION <br />El NEW [A ADDITION X ALTERATION I I REPAIR I DEMOLITION I I WOO <br />NO, <br />ONE NO. <br />CONTACT PERSON AND PHONE <br />ELL � <br />^ v � <br />CONTRACT PRICE OF WOP, �Ll�2 <br />OESC E VIA!('ND SO ARc FOOT¢C+E INVOLVED <br />g 17 + .� Yy�.ljd.l'A�n awl 3 <br />PROPOSED USE OF BUILD G (� U <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK 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 />_ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />_ <br />X r. <br />PROJECT ADDRESS l <br />P LICAN Cl BUS !E C, I ND.A F" INES ME <br />�7 <br />MECHANICAL <br />PLUMBING <br />NO, TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />' <br />�- _WATER CLOSET (TOILET) W <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />' <br />BATHTUBr r , j <br />I I UNIT HEATERS—B.T.U. M <br />& DISP <br />HEAT <br />GASI <br />STOVE <br />SUB TOTAL $ <br />T <br />$ + I <br />PERMIT $ <br />����TOTAL <br />ret <br />I <br />—� <br />TOTAL FEE $ <br />I <br />RECEIPT NO. <br />FOR OFFICE USE <br />ONLY: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER fEE <br />FRONT SETBACK <br />FEES <br />VALUATION <br />FEE <br />USE -ZONE <br />LOTAHEA <br />VACANT-IE <br />i <br />� <br />BUILDING <br />ocr xn (+oNuunG uxnS <br />GROIJP <br />cnwr <br />PLUMBING <br />+ <br />' <br />1 <br />TYPE OFC@115. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />1 <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCVLOAD <br />.FIRE SPRNKI ERS REO'D <br />HEIGHT LIMITATION <br />�— <br />OTHER <br />1 f (• G <br />o RINKLERS <br />';?!Ro%tfINTAKE <br />I <br />STATE BUILDING SURCHARGE <br />' <br />BY <br />PLANS APFROVED BY <br />CIO OF EVERETT <br />PUBLICWORKS <br />LOCAL SALES <br />Z� <br />fAX CODE IS 3185 <br />TOTAL <br />