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APPLICAT16NI FOR CONSTRUCTION PERMIT <br />Bra r <br />I <br />.1 <br />■,I <br />PRE Everoleen <br />everett <br />clTv OF e <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION Ll COMBINATION I I BUILDING MECHANICAL I I PLUMBING LI SIGN <br />OUMER MAI FEES CITY ZIP PHONE <br />i 1l, 4-L-kl11- 3 L1a�— �1 tirtL' +1�' *i 11' 3 3 1 4(c ` <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />0 A )t~).� <br />ARCHRECT DR DESIGNER MAIL ADDRESS CITY 21P PHONE <br />YECHANICALCglTRACTOR MAIL ADDRESS CITY VIIZip�I.(.�f �' pH�E_ LICEN`� <br />CLASS OF WORK <br />❑ NEW El ADDITION �AI:TERATION Ll REPAIR f 1 DEMULITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR IN RqR 0 IILY <br />CONTRACT PRICE OF WORK: ___ <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE VVRIN ANIRPOWRAMODTAGE INVOLVED <br />_ A `` // <br />PROPOSED USE OF BULL e,- <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 CONSTRUC i ION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM 1 HE 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 AUTHORI AGENT DATE <br />X 9 AA <br />d s� <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK OF <br />PROJECT ADDRESSLX <br />�/ <br />:t <br />` I <br />APPLICANTS CITY BUSIN ICENSE OBUSINESS NAME <br />I PLMsm <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER C OSET (TOILET) <br />. <br />A/C—A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />JIN <br />FORCED AIR SYSTEMS—B,TU.rXM E.A. <br />—�— <br />' <br />LAVATORY (WASH BASIN) <br />. <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />. <br />I <br />I <br />, <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $1 <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 />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES -Ilk <br />- VALUATION <br />FEE. <br />BUILDING <br />TYPE OF CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />mcupoo <br />GAWP <br />NO OF MRING UNITS <br />PLUMBING <br />' <br />SIZE OF BLDG, <br />NO. OF STORIES <br />BASEMENT <br />❑ YES Ll NO <br />MECHANICAL <br />UIHLR <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />0 YES ❑ NO <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICVVORKS <br />' <br />TOTAL <br />