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�--- APPLICATION FOR CONSTRUCTION PERMIT L• <br />the EYergreart <br />rI <br />CITY OF <br />everett <br />BUILDING DEPARTMENT 259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING Ci MECHANICAL LUMBING ❑ SIGN <br />', OWNE MAILADDRESS CITY ZIP PHONE <br />96_So `J <br />' TENANT _ MA0. ADDRESS C _5� l S� PHONE�� <br />Uo-z- P L �'e5 dGt��Jn� �I� �1tL. J <br />AR/�111RECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />V. ...DR s._f�• 7,)I o 7A FU mzn 353 G53 ) <br />kD GA .3 <br />C: H <br />>m <br />031 H H <br />xx N H <br />Cl1 O <br />HG <br />OH <br />id 0 <br />CP Y ❑Og <br />DHz <br />t" z <br />HH <br />gCA <br />H <br />LT] <br />z H cn <br />H O co <br />!if <br />Aw <br />U <br />7 ;n'f's mil , c- l a hi L I t <br />ZIP PHONE LICENSER <br />PL MBINO CONTRACTOR MAIL AooRE55e��. _.. ..._.._ <br />h12L�m1T� a,73VhliYklS.t'liC %27U b53-b`S,jcS 8�94W1D/3%R� <br />CLASdOF WORK <br />r.(....r..., n .I TCDATInM r DGDAIM F n-MOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODELONLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK: O <br />DESCRIBE WORK AND SQUARE FOOTA E INVOLVED <br />5RK' au4-�s <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />St`—C,D119-6 <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 />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <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 18.27 RCW AND 296.200 WAC. <br />SIGNATU SECOKTHACTC DATE <br />`IR OR AUTHORRED AGENT <br />PROJECTADDRE55 <br />�` ^ � Mew — <br />l•+ 1� <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 />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GASPIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />w <br />' <br />I <br />� J <br />I <br />' <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />i <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />' <br />❑ YES ❑ NO <br />TYPE Of CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OMIAWR <br />SOUP <br />wamilINGI.NITG <br />PLUMBING <br />SIZE OF BLDO, <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OTHER <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />; <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />' <br />TAX CODE IS 3105 <br />TOTAL <br />