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APPLICATION FOR CONSTRUCTIvN PERMIT <br />everett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett HEATING SYSTEM: <br />BUILDING DEPARTMENT <br />259-BB10 <br />FI DEMOLITION COMBIK'ATION BUILDING <br />EA MAIL ADDRESS CITY <br />I <br />���1i `rYJI _ <br />MAIL AUURESS CITY <br />TE�Y � - ^, D <br />11 <br />S U ELECTRIC U — <br />MECHANICAL I I PLUMBING SIGN <br />ZIP P N <br />ZIP PHONE <br />ZIP PHONE <br />CLASSOFKORK /� -- <br />I I NEW t 1 ADDITION ✓� ALTJERATION I I REPAIR 1 1 DEMOLITION WCODSTOVEiFRPL INSERT BUILDING RELOCATION <br />•�— I'{_1/E I CONTACT PERSON ANC PHONE NO <br />r.MTRACT PRICE OF WORK {•J I <br />7,Y v, -y UK-t-1 Lvt � r - _ <br />PROPOSED USE OF BUILDING , I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 (SHOWN BELOW OR ATTACH FOUR COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK - OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE: OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAN �E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF -PHIS PROPERT'I TO PERFORM THE WORK FOR WHICH <br />_ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />--- SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESS ^ /^ (� � /Z ^�� / APPLICANTS CITY BUSIN 'S LICENSE N AND BUSINESS NAME <br />TYPE OF FIXTURE OR ITLM r« - <br />WATER CLOSET (TOILET) _ - <br />AIC-A)HNDLG UNITS-H.P. <br />' <br />FLED AIR SYSTEMS <br />BATHTUBUNIT HEATERS -BTU M <br />LAVATORY (IVASH BASIN( rl nTHES DRYERS T— ` <br />SINK 8 DISP <br />—+— <br />RANGE HOOD <br />HER <br />— <br />WATER HEATER <br />TRAYWOOD <br />STOVE <br />ji <br />WASHERMETAL <br />FIREPLACE 8 CHIMNEYFIREPLACE <br />INSERT <br />FOUNTAIN <br />HEAT PUMP <br />RAIN <br />- <br />— <br />GAS PIPINGW <br />PREVENTERS <br />---i-- <br />EXF IAUSi FAN <br />ROOF DRAINS-RAINLEADERS <br />--- <br />' <br />SINK (SERVICE --BAR, <br />I <br />1 <br />' <br />SUB TOTAL <br />$ <br />�-i— <br />---- <br />FERMIT <br />PERMIT_ <br />$' <br />PERMIT <br />$ <br />' <br />__ <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />T <br />$ <br />FOR OFFICE USE ONLY: <br />_ <br />P[E <br />RECEIPTNO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEES <br />JALUATION <br />FEE <br />USE ZONE <br />lOT AREA <br />VACANT SITE <br />01 BLDING <br />� <br />TYPE OF CONTS ALLOW0.B.E <br />TYPE OF CONS7. ASiDAI <br />OCCOtANCY <br />Gewc <br />400FOARI,N:ONIIS <br />PLUMBING <br />SIZE OF BLDG. <br />No OF STORIES <br />CASEMENT <br />MECHANICAL <br />----- <br />ADDITIONAL PLAN CHECK <br />—.;_— <br />OCCUPANCY LOAD <br />FIRE EPRNNLERS REO'0 <br />UEIGIrt u6uTAnoN <br />' <br />OTHER <br />—.---r— <br />REASON FOR SPRINKI ERS <br />STATE BUILDING SURCHARGE <br />—_—�— <br />rI INS APPPOVERBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />INTAKE BY <br />LOCAL SALLS <br />TOTAL <br />S �U <br />_1__ <br />TAX CODE IS 31OF <br />