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;' <br />APPLICATI i- N FOR CONSTRUCt ON PERMIT <br />everett <br />The EWrrpreen <br />crn of <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL X PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�onn..,.�cc r'1�,�i.rPr .S�sv�ees �s9-oly6 <br />TENANT <br />MAIL ADDRESS <br />IlI♦ <br />L%-JFL ZBON@ C <br />ARCHITECT OR DESIGNER <br />MAIL ADDR SS �� <br />CITY ZIP <br />P11ON <br />1 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSER <br />bT=Eaj— <br />CLASS OF WORK <br />n N.., n AnnITInM -I AI TrPATInN Fl AFFAIR F1 DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT PAPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK: <br />DESC Igq WORK AND SQUARE FOOTAGE INVOLVE <br />'Gcarn- <br />PFKwos USE OF BUILDIN <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />,�, <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOWOR ATTACH <br />FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 1 HE 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 LA�V 18.27 CW AND 296.200 WAD. <br />SIGNATURE OF CONTRACTOR OR DATE AG] <br />`j <br />7.0 <br />— <br />rC� d- L�atic CDn�cocZ/ nc <br />PROJECT ADDRESS <br />q"? o R <br />APPLICANTS CIO BUSINESS LICENSE. NO. AND BUSINESS NAM qeAeW / <br />PLUMBING <br />MECHANICAL <br />rIp, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />__ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />' <br />i <br />I <br />I <br />I <br />SUB TOTAL <br />$ <br />; — <br />SUB TOTAL $ <br />' <br />PERMIT <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' — <br />TOTAL FEE $ <br />FRONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANr SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />❑ YES ❑ NO <br />TYPE Of CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />=ur�Ky <br />NGOFNAUII.GVNITS <br />}'— <br />GNWP <br />PLUMBING <br />S I —_ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />z) 'Sc.) <br />❑ YES ❑ NO <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS RED <br />HEIGHT LIMITATION <br />BUILDING SURCHARGE <br />❑ YES ❑ NO ISTATE <br />REASON FOR SPRINKLERS <br />�— <br />STATE ENERGY SURCHARGE <br />i <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC'NORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />