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the Evarg•eon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />APPLICA iION <br />FOR CONSTRV.:TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />• Z_ rl i si=. ___-/r A,— <br />TENANT MAIL ADDRESS CRY ZIP PHONE <br />i <br />ARCIIIIECTORDESIGN ER MMLADDRE9S CITY ZIP PHONE A C* <br />GENEs�trecoIRy�L° <br />GENERAL CONACT00 MAIL AODRE53 city 21P PHONE l•^NSC <br />MECHANICAL CONTRACIOR A IL ADDRESS CITY ZIP PHONE LICENSE <br />PLUL,B:HG CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />WS�,Y WORK <br />NFW ❑ AGDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />DESCRIBE T PRICE OF WORK WORK AND SOUARE�JIAOE IONVOlVEO/� <br />4/1 <br />PiOPOSEP SEOFBWLDINO <br />MN I(f % Fo IN i/ II..Y[,},/C�P�Ff ✓ ____ <br />CONTACT PERSON AND PHONE NOCONI.IAC. �3�3� a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT ION AND <br />IONS OF COMPLETED AND <br />KNOW THE SAME TOORDINANCESKING T AND CORRECT.FWORK ILL BE <br />ORDINANCES GOVERNING THIS TYPE H WORK WILL BE COMPLETED WITH <br />GOVERNING <br />WHETHER SPECIFIED IIEREIN OR NOT. THEGRANTING OFAPERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS WHICHAPPLICATION <br />TORCW AND <br />PROPERTY HRM THE WCRORK FOR LAW 1627 <br />AND IOMPLYWITHTHE STATE CONTR <br />296,200 WAC. <br />SIGNATURE OFCONTRACIOO ON AUTHORIZED AGENT DATE <br />APVLICANi9CITYBU51NE951.ICENSE NO ANp DUSINEss N/RIE <br />LEOALDESCRIP110N OF PROPE ISI N OEIOW OR AITAGII FOUR COI`IE9I <br />LOT BLOCr_—_ OF — <br />CAP os1L <br />PROJECT ADDRESS <br />_� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />_ <br />A/C — A/HNDLG UNITS —H.P. <br />_ <br />�1_ <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U, M EA <br />(' <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ <br />r <br />UNIT HEATERS— B.T.U. M <br />CLOTHES DRYERS <br />KITCHEN SINK&4A&P. <br />1 <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />—� <br />RANGE HOOD <br />LAUNDRY TRAY <br />� <br />WATER HEATER <br />CLOTHES WASHER <br />�_ <br />WOOD STOVE <br />--Z <br />URINAL <br />.'I <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEATPUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS— RAINLEADERS <br />FXHAUST FAN <br />SINK(SERVICE — BAR. ETC) <br />-- <br />SUBTOTAL <br />$ <br />`_ <br />— <br />SUBTOTAL <br />PERMIT <br />$ <br />PERMIT <br />TOTAL FEE <br />$ <br />1 0 <br />TOTAL FEE 9 <br />FRONT SETBACK <br />C9_0 <br />REARSETOACK <br />O' <br />VDE SETBACK <br />5� <br />PUN CHECK NUMBER <br />3 (v <br />FEE �> <br />3a7 —J <br />RECEIPT NO <br />173Q� <br />USE 7Q,, <br />I�{Y`J r <br />LOTAREA <br />vec�Ni 911E <br />E9 Ll NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING 2v76 K 91 <br />6 <br />� <br />�7 <br />r <br />TYPE OF CONST. <br />ulowABLE/AcAJ,_ <br />UPANCYGOUP <br />R_-3 <br />NO. DWELLING UNITS <br />/� <br />PLUMBING <br />slzE or ❑LDG <br />22`/ <br />NO OF STORIES <br />2 <br />psMt. <br />o Y <br />{G-N <br />OCCLOAD <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SPRINKLERS REOUTAED DYES tCDD <br />HEIGHT LIMITATION <br />STATE BUILDING <br />SURCHARGE <br />APPLICATION ACC BY PLANSAPPR. BY <br />��, �✓� <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />