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APPLICAti�N FOR CONSTRU�.TION PERMIT <br /> everett <br /> �haE��,�� e <br /> an oF <br /> everett � <br /> � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOUTION f7 COMBINATION L;"BUILDING F'MECHANICAL !-�'PLUMBING ❑ SIGN I <br /> OWNER MAILADOPE55 ' y�ITV� 21P PHONE I <br /> � ja, (F�-/ r r�f°�/f ��''a� " / �,C+'j -/ <br /> � MAILAOORE55 CiTY ZIP PMONE <br /> ����� ��r/�� <br /> ARCHITECTORDE51/GN ER MAILAD�RESS CITV 21P PHONE <br /> Y' 1 /77 � 4�� ,illd /'�� �i�✓ <br /> GENE ALCIXJ RACTOR � MAILADOfiESS � CITY ZIP PHONE LICENSE� <br /> MECHANICALCONTRpCTOR MAILADDRE55 CITY ZIP PNONE LICENSEM <br /> PLUMOINGGONiRACTOR MAILAUDRE55 CIN ZIP PHONE IIGENSEI <br /> CLA55y F WORK <br /> r'✓FjEW I. i ADDITION C] ALTERATION ❑ REPAIR �_� DEMOLITION �� WOODSTOVE�FRPL�NSERT ❑ BUILDING RELOCATION <br /> TEN�NT IMPROVEMENTOR INTERIOR PEMOOELONLV CONTACT PERSON AND PHONE NO. <br /> CONTRAGT PRICE OF WORR: <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br /> / i � <br /> PRO OSEDUSEOFBUILDING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �� APPLICATION AND KNOW THE SAME TO BE TRUE AND COARECT.ALL <br /> LEGALDESGFIPTIONOFPROPERTV�SMOWNBELOWORA7TACHFOURCOPIES PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> c� � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK . / oF 1 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � Q / -�'� C. 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 /> CONTRACT RS LAW 182J RCW AND 296200 WAC. <br /> SIGNANR CONTP�Q��MORIZE AGENT DATE <br /> j/� �/ ���i�✓ <br /> X � �4 ' , t / , �� .� : <br /> PR0.IECT R�RESS - <br /> 5 � APPLICANTS CIN BUSINESS LI ENSE NO.AND BUSINE55 NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> 'i WATER CLOSET(TOILE� NC—A'HNOLG UNITS—H.P. � <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> IAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' / CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � 'lENTILATION FAN � <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WA��Efl HEATER ' <br /> CLOTHES WASHER � WOOD STOVE _� <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY �C� <br /> �RINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � I <br /> � � <br /> � � � <br /> � <br /> � ' i <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL 5 <br /> PEFMIT 5 � PERMIT $ � <br /> TOTAL FEE S ' TOT'AL FEE S ' '� <br /> FRONT SETBACK REA SETBA K -/ SIDE SETBAC. PLAN CHE K NU BER FEE REL IPT N I <br /> .a� � � � � , � -.�.�- ��o3a �a �s �a� <br /> use z e �or REA � VACANT SITE FEES ¢VALUATION FEE I <br /> —1 ,� h�y,� ` ;✓�ES Ll NO BUILDING 'I'82 ' � <br /> tVPf Of CONSi.ALlOWRBIE TYPE Of CONST RCT RL otCureucr NO Of pMLLiNG�NrtS � I <br /> �a�P r PLUMBING � C <br /> _ - -3 � L <br /> SRE Of BLDG. NO.OF STOflIES BASEMENT MECHANICAL � I <br /> 4 g 2 ! 1 YES }( NO � I <br /> OCCUPANCY LOAD FIRE SPRNNLERS REO'U HEIGMT LIMpITATION OTHER � � � <br /> _�j � ❑ YES ,X NO Z 0 r STATE BUILDING SURCHARGE ' � <br /> REASON FOR SPRINNLERS <br /> STATEENERGYSURCHARGE i <br /> i <br /> APPLICATIONACC.BY PlANSRPPF�DOV CITYOFEUERETT PUBLICWORKS � <br /> 9 LOCALSALES � <br /> TAX CODE IS 3105 TOTA� o ' �� <br />