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APPLICATItA FOR CONSTRUCT rON PERMIT <br />everett <br />Evergreen CI e <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />❑ DEMOLITION L1 COMBINATION Ad BUILDING ❑ MECHANICAL f:] PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS n/5. SST � �-r.(_ AZ I —1��L PHONE <br />TENN.ANNT�,/,..MAIL <br />ADDHR]ESS <br />CITY <br />ZIP <br />PHONE <br />CV C/C ♦� LI rttv���%✓'f' <br />cI <br />c n <br />TITn,� <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />.' 72-2 <br />��L D CITY � V € <br />ZIP <br />�i/tt7CET� <br />PHONE <br />Utl /�'d�20 <br />35"3 <br />�rs+l� V <br />k/yQ r✓ <br />5-4 % GLt�O <br />/9I iT BLl7 <br />,2& <br />GEN��AC R <br />ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />�IL <br />MECHANICAL CONTRACTOR <br />MIL DDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE# <br />7"n /:C A. 461M <br />14 A/CEP <br />PLL M�(BYI�NGCCOONNNTTRACTOR <br />MAIL AUUKE55 <br />CITY <br />ZIP <br />PHONE <br />LICENSE 0 <br />(— <br />OLA55 OF WORK <br />r­i .rein RY AnnITInAI <br />n AITPRATIFIN R RFPAIR ❑ DEMOLITION <br />❑ WOODSTOVE/FRPL INSERT <br />F <br />❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMOD ON)LY <br />CONTRACT PRICE OF WORK: 7 DG <br />CONTACT PERSON AND PHONE NO. <br />L7 -�J`-717- 4AWS <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Ob Qf6V <br />s 0ZA G-C <br />PROPOSED USE OF BUILDING <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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18. Z RCW AND 296.200 WAC. <br />SIGN A E FCO CT 7UTHORIZED AGENT DATE <br />X <br />LEGAL DE7i.RIPTiO"I OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECTADDRESSI/ <br />�I e/ 'Co kiprp YY% ,/ 06� <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO.. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />-0 <br />WATER CLOSET (TOILET) <br />_ <br />A/C-A/HNDLG UNITS-H.R <br />- <br />;NS <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS-B.T.U. M <br />I <br />;} <br />SHOWER <br />KITCHEN SINK 8 DISP <br />' <br />CLOTHES DRYERS <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />_ <br />LAUNDRYTRAY <br />' <br />WATER HEATER <br />' <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />- <br />- <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />$ <br />; <br />SUBTOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />— <br />TOTALFEE <br />T <br />$ <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHEC NUMBER <br />FEE��� ^C <br />l <br />RECEIPT NO. <br />USE ZONE <br />�_ <br />LOT AREA / <br />I <br />VACANT SITE <br />❑ YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />' <br />TYPE O. FCOdST.ALLOWABLE <br />SIZE OGF BLDD. <br />TYPE OF CONST ACTUAL <br />NO, OF STORIES <br />C".P.Cv ..-m—mmGums <br />a°U'Z <br />BASEMENT _ <br />❑ YES NO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />' <br />' <br />OCCUPANCYLOAD <br />C/P <br />FIRE SPPUU'ERS REO'D <br />❑ YES X NO <br />HEIGHT LINLTATIfJN <br />LL....JJ <br />STATE BUILDING SURCHARGE <br />, <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />I <br />I <br />APPLICATION ACC. BY <br />PLANS APP OVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />i <br />TOTAL <br />) <br />IN <br />