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APPLICAJON FOR CONSTRb%FTION <br />PERMIT <br />the EmMmen everetl <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269-8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAILADDRESS CITY 21P PHONE <br />w aii _T ., I n J% Ars SswPP/t_ `lamIf 9y7-pi�2 <br />uriTECT OR UE: <br />AENERALCON' ACTOR <br />MECHANICAL CONT R MAIL ADDRESS ''7yZIP PHONE LICENSE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />CLASSOFWORK n n IueeoT n RUII DING RELOCATION <br />❑ NEW U ADDITION In ALTERATION IJ HEHAIH u vcmvLmv• <br />CONTACT PERSON AND PHONE NO. <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONUf- <br />i7yy <br />CONTRACT MICE OF WORK <br />pEBCRIBEWORKANDSOUAREF00TAGEINVOLVEO Qtp/lqCC `O? <br />IN G f JGy. /A. #,e , . <br />Al �.M BA <br />USE OF BUILDING F%r. %,J <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />OPOSED <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE OMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTINGOFAPERMTDOE8 NOT <br />ISNOWN BELOW OR ATTACH FOUR COPIESI <br />LEGAL DE I <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OTHER SW TE OR LOCAL LAW REGULATINGPER- <br />LGT BLOCK OF <br />FORMANCEANY <br />CTION. HATH AM AUTHORIZED BY THE OWNER OF <br />OF CONSTRUCTION. <br />ID PROPERTY TO PERFORM THE WORK FOR WHICH N IS M ADE <br />ANI COMPLY W WITH HE STATE CONTRACTORS LAW 1B27ORCW AND <br />296,200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZE D AGENT DATE <br />6j�r e, 9 zo-8p <br />X <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS IICENSE NO AND BUSINESS NAME — <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — A/HNDLG UNITS —H.P. _ <br />WATER CLOSET (TOILET) <br />IE! <br />FORCED AIR SYSTEMS —ELT.U. MEA <br />BATHTUB <br />I.� <br />�." <br />UNIT HEATERS — B.T.0M . <br />LAVATORY (WASH BASIN) <br />El <br />CLOTHES DRYERS <br />_ <br />SHOWER <br />Q <br />VENTILATION FAN <br />KITCHEN SINK 6 DISP. <br />RANGE HOOD <br />t <br />DISHWASHER <br />'f <br />WATER HEATER <br />LAUNDRYTRAY <br />— <br />WOOD STOVE <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />SINK(SERVICE — BAR ETC.) <br />�I <br />GAB PIPING <br />EXHAUST FAN <br />AL <br />u <br />b� <br />L- <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT S <br />CU <br />TOTAL FEE $ <br />TOTAL FEE $ <br />REAR SETBACK SIDE SETBACK <br />PUN LNECK NUMBER FEE RECEIPT NO. <br />FRONT SETBACK <br />USEZONE <br />LOT AREAO <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />o <br />YES ❑ NO <br />BUILDING <br />a c <br />TYPEOFCONST. <br />OCCUPANCYOROUP <br />NO.OF DWELLING UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />NO. OF STORIES <br />G <br />OCLOAD <br />MECHANICAL <br />�M�Mee <br />SIZEOF BIW. <br />YT. <br />0 <br />❑ N <br />OTHER <br />C "• <br />HEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REWIRED O YES ❑ NO <br />STATE ENERGY SURCHARGE <br />. APPLICATION ACC, BY PLANS APPR BY <br />PUBLIC WORKS <br />�� <br />TOTAL <br />I' <br />