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APPLICATIOIE� FOR CONSTRUCTiJN PERMIT <br />rJ <br />TO BE COMPLETED IN INK <br />—PLEASE PRINT <br />Me Evargrren <br />CITY OF <br />everett <br />HEATING SYSTEM: ❑GAS <br />❑ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />SIGN <br />MECHANICAL PLUMBING <br />;_i <br />' ; DEMOLITION COMBINATION BUILDING <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />TENANT MAIL ADDRESS <br />G r �-v .we � <br />// CITY <br />%%IAtL �k C l 1 Bl�� <br />21P PHONE <br />�< <br />CRY <br />/ 'IP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS <br />GENERAL CONTRACTOR MAILADDRESS <br />CITY <br />ZIP PHONE LICENSES <br />O K •hwu co�ST- <br />LITY <br />ZIP PNONE LICENSE$ <br />121 97 <br />MECNANh:AI CONTRACTOR MAILADDRESS <br />i .a. e. r.� /i.�- <br />947ai 2573!/4 LNKX6S <br />lri7 <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHDNE LICENSE <br />H <br />C DL <br />z tc M <br />H O UL <br />M <br />—aiM. <br />CLASS OF WORK _ <br />I- NEW C✓ADDITION UP/ALTERATION REPAIR !._! DEMOLITION WOODSTOVE/FRPL INSERT J BUILDING RELOCATION <br />OON TPEHsury nrvN rnvno n... <br />-.�1 Sa Ltd GSZ— �(1 <br />CONTRACT PRICE OF WORK <br />SCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />IMP V+FR/lC Il�4lG.0 I}C LT <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION (IF PROPERTY (SHOWN BELOWOR ATTACH FOUR COPIES) <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 />ORIZED AGENT DATE q'1,3ty <br />SIGNATURE OF CONTRACTOR OR AOHO <br />X J/ � ' J <br />c� p <br />J �J <br />7�� <br />OJEC'FADORESS <br />-sL.. �sv ...�`�y� <br />/402�..-✓G Y�r �' 1 <br />ii <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />I <br />SUB TOTAL $ <br />D' <br />S� _ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />/ ' _ <br />YUIY VE'PIL:C UJC <br />FRONT SETBACK <br />uNLY: <br />REAR SETBACK <br />SIDE F^.TBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />vncaNr sliE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />ME OF CONTS. ALLOWABLE <br />TYPE OF CONST, ACTUAL <br />OauxNtr <br />GRWP <br />NO WVI UNITS <br />MECHANICAL <br />I _ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHTLIMITARON <br />REASON FOR SPRINKLERS <br />OTHER <br />I <br />STATE BUILDING SURCHARGE <br />' <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BV <br />--- — <br />�L S <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/O� — <br />