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the L'v=yreen <br />CITY 0P <br />everett <br />BUILDING DEPARTMENT <br />259-AB10 <br />APPLICi�fION FOR CONSTR4*.PTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />AR...•ITECT OR DESIGNER MAILADDRESS ally ZIP PHONE <br />GENEFAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CON) FACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR <br />MAILAUDRESS <br />CITY ZIP <br />PHONE LICENSE <br />Ii/K,"'S 1{I! I/�ty <br />P?m 'o <br />y/YN. <br />M/Kc1S4zLp2rq <br />CLASS OF WORK <br />NEW ❑ ADDITION ❑ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ IAOOOSTOVE/FRPL INSERT <br />❑ 13UILDINGFIELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PR „E SEOFBUILDING <br />I HEREBY CERTIFYTHAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT 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 />FORMANCEOFC, >TRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OFCONTRACTOn� OR AAUTHOnIZEDAGENT DATE /' �` <br />�y/ ///' -/ O — O C,F <br />LE L sc IPTION OF PR PER"(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PROJECTADDRESS <br />TT 1U <br />APPLICANTS CITY BUSINESS LICEFt;NO. ND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />VEE <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— R.T.U. M EA <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />UNIT HEATERS— RT.U. M <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP, <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />/ <br />WATER HzATER <br />GlT <br />CLOTHES WASHER <br />WOOD STOVE <br />4r <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS _ <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE.— BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />3 <br />S <br />_ <br />_ <br />SUBTOTAL S <br />PERMIT <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />FRONTSETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CH ECK NUMbER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />TYPE OF COAST. <br />ALLOWABLE/ACTUAL- <br />LOT AREA <br />OCCUPANCYGROUP <br />VACANTSITE <br />O YES D NO <br />NO. OF DWELLING UNITS <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BSMT. <br />G Y <br />DN <br />OCG LOAD <br />MECHANICAL <br />FIRE SPA.NKLERS REQUIRED ❑YES ❑NO <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. EY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />