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1 <br />I <br />APPLICA, Yi JN FOR CONSTRUE v`ION PERMIT <br />the Emrgwn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-B810 <br />❑ DEMOLITION 9 COMBINATION IJ BUILDING CI MECHANICAL <br />..aMAILADDRESS CITY ZIP PHONE <br />❑ PLUMBING 0 SIGN <br />, <br />TENANSecv`7 . MAILAZ16 PHONE <br />ADDRESS <br />CITY <br />QCS <br />ARCHITECT OR GESIGNER MAIL ADDRESS <br />CITY ZIP PHONE <br />/�/ LEI) <br />LpL.CI (ain n-,n I . �.n s_.� (' ��,{} e�c�� 4 ( c SE p ,r i <br />IF%Y� _. - . <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE# <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE II <br />I wnnncTnVFIFRPI INSFRT I l BUILDING RELOCATION <br />O NEW U AUON IUN <br />TENANT IMPROVEMENT OR INTE,RK)R REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />/ ' 3 / <br />'�� II <br />CONTRACT PLAICE OF WOEIK: JhP <br />DESCRIBE WORK AND SQUARE F ACIINVOLVED <br />iyoo -TPI,G <br />t2obL,nhs ass - <br />PROPOSED USE OF BUILDING <br />I HEREB CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />• I,j dyh <br />APPLICATION <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEG DES'RIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOURCOPIES) <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 />_ <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />61 t�xkewc/y8o-D <br />e <br />O=f�(k Clc,n iCtiLn EOrs Tn C <br />APPLICANTS CITY INESS LICENSE NO. AND BUSINESS NAME <br />ECT ADDRESS <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C—AMNOLG UNITS—H.P. ' <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />I <br />UNIT HEATERS—B.T.U. M <br />' <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />' <br />I <br />CLOTHES DRYERS <br />_ <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK & DISP <br />' <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />, <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />— <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />--� <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.)SUB <br />W$! <br />SUB TOTAL <br />TOTAL <br />$ <br />PERMIT <br />$PERMIT <br />FEE <br />TOTALFEE <br />$TOTAL <br />SETBACK <br />REAR SETBACK <br />SIDE SETDACN�� <br />NUMOEO FEE ii <br />_t I —CStUSE <br />RECEIPT NOFRONT <br />E <br />LOTAREA <br />VACANT SITE <br />FEES VALUATIUN <br />FEE❑YES <br />C NO <br />!ANCIC <br />G <br />3C pcC''5 <br />—1Yf40 <br />a <br />T. ALLOWABLE <br />TYPE OF CO All; l <br />L'LCIIPAWY NGOINSTIUNG0115 <br />P/.`+r1G <br />SIZE UE BLDG. / <br />NO. OF STORIES <br />BASUAINT <br />Ll NO <br />MECHANICAL <br />' <br />OTHER <br />YES <br />OCCUPANCY LOAD FIRE SPRNKLER RR///EOD <br />HEIGHT LIMITAT <br />El YES yC� NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY <br />PLANS APPRO+ED Y <br />CITYOF EVERETT <br />PUBLIGWORKS <br />„^ <br />VA <br />/ <br />�'"l I <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />