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I <br />I <br />APPLICATION FOR CONSTRUCTION PERMIT <br />• everett <br />NI. Evergreen e <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION IJ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />IMIRESS CITY ZIP PHONE <br />OWNERu PHONE <br />- <br />TENANT MAIL ADDRES CITY ZIP <br />�ii•1 IMF (A//�� .O Q .F�� <br />ine .r <br />........ .... .,. ce CITY ZIP 'HONE <br />I <br />CLASS OF WORK k--I -_ _ I - r-t neunl ITInM ❑ UUnnncTnVF/FRPL INSERT ❑ BUILDING RELOCATION <br />LJ NEW Li AUUFIIVIN /c rncl cnn nv:. <br />" ..... — _- <br />TENANT MPRCVEMENTWIIN RIOR Y <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORN: <br />DBE TAGE INVOLVED <br />,� _ _ �� /•, �i <br />PROPOSED USE OF BUIL /—,�,/�� <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <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 />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 AUTHORLZt AGENT DATE <br />APPL TS CNY BU81NE <br />IC NSE N 10 BUSINESS NAME <br />PLUMBING <br />x!I' <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER C OSET (TOILET) <br />' <br />AIC-AIHNDLG UNITS-H.P. I <br />' <br />FORCED AIR SYSTEMS--B.T.0 E.A. ' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />I <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />, <br />I <br />' <br />SUBTOTAL <br />S <br />I <br />- SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />i" <br />TOTALFEE <br />$ <br />I <br />TOTAL FEE $ <br />'r <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />' <br />I <br />' <br />❑ YES ❑ NO <br />TYPE OF CONSTALOWABLE <br />TYPE OF CONST. ACTUAL <br />p�uwPcr <br />sxaP <br />xa a owLwxs units <br />SIZE OF BLDG. <br />NO. OF STORICS <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OTHER <br />; <br />OCCUPANCYLOAD 4A FIRE SPRNKLERS REO'D <br />HEIGHT LIMITATION <br />I <br />❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />ST^TE ENERGY SURCHARGE <br />' <br />REASON FOR SPRNKLERS <br />' <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />■ <br />D■ <br />1 <br />