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APPLICAT14�r+1 FOR CONSTRUCT dN PERMIT <br /> everett <br /> !he Eve�g�een � <br /> an oF <br /> �verett � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION ��'COMBINATION QBUILDING i�� ECHANICAL �LUMBING ❑ SIGN <br /> pWNER MAILADDRE55 CITV ZIP PHONE <br /> �C�I�EN7AG 6L22 �T�1!-��u.�fi dwr Pi� 9f�X.2 �i!/Glee� 7f'3�c�5/ <br /> IENANT MAILAODRE55 T' Z�F PMONE <br /> ARCHRECTORDESIGNER MAILADURESS CIN ZIP PHONE <br /> ,D�N � c.uwil�c �o;tar �Yi��a�c su� s�-rrlP 9'B/y6 937�'7•2B <br /> GENERALCONTRALTOR MAILADDRE55 CIN ZIP PNONE LIC'cNSE1 �....t.�N� <br /> iTri <br /> ]'7 f,vu .em,. bbs�es /6.?!R 1�a�el��rie /�Fii! 77illGCefK Y�/a �f37�iS� lz�44 <br /> MECHANICALCONTRACTOH MAILADDRE55 GIiV ZIP PMONE UCENSE� <br /> PLUMBINGCONTR:.CTOR MAILADDRE55 CITV ZIP PHONE Llf°NSEN <br /> '. CUSSOFWORK <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOUTION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING FELOCATION <br /> ' TENAM IMPROVEMENT OR INTERIOR REMODEL ONLY � CONTACT PERSON AND PHONE O. <br /> �' <br /> . CONTMCT PRICE OF WORK: /��G <br /> DESCRI9E WOflK AND SOUAPE FOO'AGE INVOLVED <br /> Ne.w � n.�T lt�6� <br /> PROPOSEDUSEOFBUILOING I HEREBY CeRTIFY Tf1AT I HAVE READ AND EXAMINED THIS � <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL I <br /> LEGALDESCRIPTION OF PROPERTV�SHOWN BELOW ORATfACMFOUR COPIES) PROVISIONS OF LAYlS AND ORDINANCES GOVERNING THIS TYPE OF I <br /> - WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> .. �oT�_ e�ocK oF WOO NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE ; <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> . R � IU� � P� � OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THF � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �� C OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> f � APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> L�L�Y ..IVd SIGNRiUREOFCONTRACTORORAUTHORIZEDAGENT DATE <br /> wI'N� <br /> PRQIECTADDRE55 <br /> AVPUCAN CITY�U51 E I SE NO.AN SS NAME <br /> P. <br /> PLUMBIN6 M[CHANICAL <br /> NO. TYPE OF flXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE � <br /> '� WATER CLOSET(TOILET) r A/C—A/HNOLG UNITS—H.P. <br /> BATHTUB ;� FORCED AIR SYSTEMS—B.T. E.A. � _ , <br /> LAVATORY(WASH BAS�N) i � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' — CLOTHESORYERS � � <br /> KITCHEN SINK 8 DISP � 'Z. VENTILATION FAN ; .. <br /> DISHWASHER � RANGE HOOD � I <br /> LAUNDRYTRAY ;_. WATER HEAI'CA ' I <br /> CLOTHES WASHEfl �— V/0CD STOVE i <br /> URINAL ' METAL rIHEPLACF F,CHIMNEY ' ^ I <br /> � DRINKING FOUNTAW � i FIREPLACE WSERT i � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; �' GAS PIPING ; i <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; ' Ii <br /> � � <br /> � ' I <br /> � <br /> � � <br /> i � � <br /> SUB TOTAL $ 1 ;— SUB TOTAL $ " ^ ' <br /> � PERMIT $ �— PERMIT 5 � , <br /> TOTAL FEE $ — TOTAL FEE $ ! —' �, <br /> FRONTSETBACK REAflSETHACK SIDESETBACN PlA C EfJ(1�@� FEE � IQ RE�EIPTNO. � �I <br /> ��, '.�/ � U f�\ � l l . <br /> I <br /> USE ZONE LOT AREA VALANT SITE FEES VALUATION FEE I <br /> — 1 �y [� �YES ❑ NO BUILDINGc� � _ �S " � �' � � ��� I <br /> TVPEOFCONSiALIOWABLE TVPEOf ONSi.�CiUAI «C�Hcr xoWowtLLiNGUNi15 � ' <br /> �� + PLUMBING ^' , <br /> SIZE�BL�y ��� NO.OFSTORIES OASEMENT MECHANICAL ��i� _� , <br /> l � � ❑ YES U NO <br /> OCCUPANCY LOAD FIPE SPRNKLERS REO'D NEIGMT LIMITAT�N <br /> OTHER i I <br /> ❑ VES ❑ NO i` � <br /> Z STATE BUILDING SURCHARGE L-�� I <br /> REASON FOR SPPINKLERS <br /> STATEENERGYSURCHARGE i ' <br /> APPLICATIONACGBV PLANSAPPFOVED�Y CITYOFEVERETT PUBLICWORKS � <br /> .�-1�' 1 LOCALSALES � �a`� � <br /> `�1J`� TAl(CODE IS 3705 TOTAL <br /> G��it � It���`-y u�1 ��C� Fcc�i����,L eC � I <br />