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APPLICATION FOR <br />CONSTRUCT►JN <br />PERMIT <br />everett <br />L' <br />TO BE COMPLETED <br />IN INK --PLEASE PRRdT <br />. <br />the Evergaen <br />CITY OF <br />,e. <br />everett FREATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />r y <br />i DEMOLITION COMBINATION C! BUILDING <br />I-- MECHANICAL <br />❑ PLUMBING <br />SIGN <br />Lx] <br />OWNER MAIL ADDRESS <br />CITY ZIP PHONE <br />,� x <br />BUNG SE.FUFIi�raai <br />[J�r(�tt51E1T/982a3 <br />745- /786 <br />C H <br />TENANT MA ADDRESS <br />CITY / IP PHONE <br />E~ En <br />/�^� �r/837/ N �Alra?STi?E AVE <br />/PA2r D/Z 97017 (sa'i) <br />285- 'asw <br />ARCHITECT OR DESIGNER MAILADDRESS <br />�f+.C�ITIY.»r <br />ZIP PHONE <br />IyC A <br />o��w+ <br />II/JAn/CP %jtl7."CnAN/,L7UVC E'y�/d <br />�7YG�c�QB�03 S�i'OT7� <br />1-3 <br />GENERAL CONTRACTOR M IL ADDRESS <br />CITY ZIP PHONE LICE A <br />J_y <br />98g9&sJCO�� <br />H3 <br />Z <br />MECHANICALCONRSSw/rla�A <br />CITY ZIP PHONE <br />LICENSE <br />y <br />Q Hi <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONF <br />LICENSE) <br />WOE <br />Hy C <br />CLASS OF WORK <br />I i NEW El ADDITION ALTERATION Cl REPAIR <br />Li DEMOLITION ❑ WOODSTOVE/FRPLINSERT <br />❑BUILDING RELOCATION <br />9Ht�J <br />H F3 <br />N <br />H <br />C]C7ti <br />tsl <br />I-B 00 cl <br />ryry�� �-YA-Y� <br />CONTRACT PRICE OF WORK e'ny (00 OC <br />CONTACTPPE/RRSON (!1ND PHONE NO, <br />rIR�J �JZ17 0 ✓/`S_ <br />DESCRIBE WORK AND SOUAREFOOTAG <br />PRO PO BE o BUILDfj <br />I <br />1 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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NO F. 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 />PERFORMANCE OF CONSTRUCTION. THAT 1 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 />SIGNATURE OF CONTRACTOROR AUTHORIZED AGENT DATE <br />X <br />- <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PRO.T�E{CqT ADDRESS '/ rp�--/� <br />C/[�`/ L <br />// VZ S.E. Ev6zrc T y <br />APPLICANTS CITY BUSINESS LICENSE NO. DBUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />( <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />I <br />SUBTOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECK UMBER <br />FEE <br />FIE <br />LX <br />]W <br />L'•�/ <br />USEZO <br />C2 <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />BUILDING <br />ZO pC� a <br />C-'O <br />I <br />ONON <br />TYPE OF ONiS. ALLOWABLE <br />TYPE OF LONST ACTUAL <br />acCuoANn' <br />xoa PYIfGING UNiis <br />PLUMBING <br />OF BLDQ. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />GSIZE <br />riAwT-4 <br />1 <br />u>ua <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCYLOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />AID N4T`I g EYI51 Go <br />OTHER <br />REASON FOR SPRINKLERS <br />( <br />ii <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVER ETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />� / ; <br />