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:,. • . . . .. . .. .. ,. -� ,__.. <br /> .. .. . . _ _ .. , <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> everett <br /> flre Evergre5n <br /> CIiV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259•8810 i <br /> ❑ DEMOLITION I I COMBINATION I I BUILDING fL11AECHANICAL I I PLUMBING I.l SIGN <br /> ��Ep MRIL AO�RE55 CITV 21P PNONE i <br /> .�-,ru�k.c (�a,11 so�2 - 1�1e1w��.� ,4�.� ��� zs2-� 53oZ <br /> TENANT MAIL DDRE55 GITY ZIP PHONE <br /> ARCHITECTOR�ESIGNER M�ILADDRE55 ��TY Z�P PM���E <br /> GENERALCONTRACTOR M�IL ADDRESS CITV 21P PHONE LICEHSE� <br /> MECH�NICAL CONTFACTO MAIL ADDNE55 CIN 21P PMONE LILENSE t : <br /> N w w..(�,- Lw�- �G,�. �iro �4,�� a„t ���r z�r-s�;�� N�Fr.�� r3� k � _ <br /> PWMBINGCONTiiACT017 MAILADDRESS <br /> CITY ZIP PHONE LICENSER � <br /> CUSS OF N'ORK � <br /> O NEW ❑ ADDITION �ALTERATION I-I REPAIR I�.J DEMOLITION I.I WOODSTOVE/FRPLINSERT ❑ BWLDINGRELOCATION : <br /> 6 <br /> TEN�NT IMPROVEMENT OB INTEHIOB REMOD�EL OuNIY COI ITACT PERSON PND PNONE NO. ' <br /> CON7N�CT PRICE OP WORN: <br /> �Z 1 U <br /> 1 <br /> DESCRIBE WORN AND SWANE FOOTAGE INVOLVED � <br /> �7fA2L � �'lf1n� j <br /> pporoseouseoFew�oir+c I HEREBY CERTIFY THAI' I HAVE READ AND E%AMINED THIS <br /> �� y,�•, APPLIC�TION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL �� <br /> LEOALDESCRIPTIOf OF PROPEi N�SHOWI BELOW OflATTALH Ff 11�LOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITFI WHETHER SPECIFIED HEREIN OR <br /> �or s�ocK or NOT. TfiE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE I' <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE �. <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE , <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOHK FOR WHICH !'; <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE �� <br /> CQNTRACTORS LAW 18.27 RCW AND 296200 WAC. �1� <br /> SIGNATURE OF CONiR�CTOROR AUTMOR2ED AGENI DATE 4� <br /> _- y + <br /> PROJECTADDRESu A //' �f�1�IK // �' �' <br /> APPIICAN.'S CITV BUSINE55 ICENSE NO.AND BUSINE55 NAME i <br /> PLUMBIN6 MECHANICAL i <br /> NO. TVPE OF Fl7(TURE OR ITEM FEE N�. TYPE OF EUUIPMENT FEE � <br /> WATEF CLOS=T(TOILET) � NC--A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FOFCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i ' <br /> SHOWER ' C•LOTHES DRYERS _ ' � <br /> KITCHEN SINK 8 DISP � VENTILATION FP."! � ' <br /> DISHWASHER —'— RANGE HOOD �_ � <br /> WATER HEATGR ' <br /> LAUNDRYTRAY � � <br /> CLOTHES WASHER � WOODSTOVE � , <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY ' ' <br /> i <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR ORAIN ' � !1EAT PUMP ' <br /> BACKFLOW PREVENTERS ; _� GAS PIPING _� � <br /> ROOF DRAINS—RAINLEADERS � _ EXHAUST FAN ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) i � <br /> � <br /> ----�— <br /> � <br /> — � <br /> � ' <br /> � <br /> � <br /> � ' <br /> SUB TOTAL $ � SUB TOTAI $ ' <br /> PERMIT $ � PERMIT S � � <br /> TOTAL FEE $ ' TOTAL FEE $ f 'O U f <br /> FRONTSETBACK RERRSETBACK SIOEeETBRCK PLANp1ECKNUMBER FEE RECEIPTNO. . <br /> � <br /> USEZONE IOTAREA VRCANTSITE FEES VALUATION FEE �, <br /> I-IYES I�INO BUaDING ' � <br /> iVPEOfCONSTALIOWABIE 7VVEOFLONST.ACNAL otnioMitr xoaoWuuNGUHiR � <br /> �pp�P PLUMOING � <br /> 1 I <br /> T� <br /> 1 <br /> SIIEOFBIW. NO.OFSTORIES OASEMENT MECHpNICAL � <br /> 17 YES I.J :d0 ; <br /> OCCUPANCVLO�D FIRESPPNKLERSflEO'D IIEIGHTLIMITATION OTHER � <br /> i <br /> ❑ YES (7 NO STATE BUILDING SURCHARGE � <br /> �r— <br /> REASONFOHSPRINKLENS � I <br /> STATEENERGVSURCHARGE � i <br /> �PPLICATIONRGC.BY PLANSAPPPOVEOBY CITYOFEUEflETT PUBLICWORNS � � <br /> LOCRLSALES � ' <br /> TAX CODEIS 3105 TOTAL ' <br />