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r�t r� �t_'a�� <br /> APPLICATIIy`N FOR CONSTRUCI''�ON PERMIT <br /> � • everett <br /> � fhe Evnrpreen <br /> i CITY OF � <br /> � everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK-PLEASE PRINT <br /> � 259•8810 <br /> ❑ DEMOLITION ❑ COMBINI�TION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEN MAILrA�DOAEI�5 CITY 21P PHONE <br /> rn(� 1\Ifd 7t�q Lornbr�ZD Av�. Ei�e.��f-9�1 z-52���� <br /> TENANT MAILADOfiESS CITY ZIP PNONE <br /> ARCHITECTORDESIQNER MAILAODRESS CIiV 21P PHONE <br /> QENERRLCONTRACTOR MAILADDPESS CITV 21P PHONE ��CENSEI <br /> MEGHA1tICALCONiRACTOB M ILAUDflF55 CIN ZIP PHONE IICENSE/ , <br /> ,•�,-�LT Cc,-sir"�R ..�c -...�o ��� -11 - <br /> PLUM9INQCONTRACTOR MAILADDRE55 CITY I ZIP PHONE LICENSEI <br /> I <br /> i <br /> CLASS OF WORH <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION �WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br /> TENPNT IMPROVEMENT OR INTERIOR REMOOEL ONLV CONTACT PERSON AND PNONE NO. <br /> CONTRACT PRICE OF WORN: <br /> DESCAIBE WOfil AND SOUA�OOTAGE INVQLVEO����� - <br /> 1 =y 7 n . ���� <br /> �.vla�C�L <br /> PROPOSED EOFBUII�INO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> � LEGALDESCRIPTIOHOF PROPERTY(9HOWN BELOW ORATTACH FOURCOPIES) PROVISICNS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br /> � WORK WILL 6E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �pT e�xK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B Y THE <br /> � <br /> i OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> j APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATUPEOFCONTH�CTOflOFAUTHORIZEDAGENT UATE <br /> � �pI flQIECT ADDRESS ��-�+-�'-�{—� b'`A �� — <br /> y Z1 ,^ _^ rj� 1�p r APP�IC� TS CITV BUSINE55 LICENSE NO.PND BUSINE55 NAME <br /> �� .,� ��r 1 Ky u�� G <br /> i PLUMBING MECHANICAL <br /> � � NO. TYPE OF FIXTURE OR REM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEfl CLOSET(TOILET) � A/C-A/HNDLG UNITS-H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS-B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN) i UNIT HEATERS-B.T.U. M i <br /> � SHOWER �' ' CLOTHES DRYERS ' <br /> �. KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> ����+ DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY � � WATER HEATER ' <br /> a � CLOTHES WASHER � WOOD STOVE ,�__ <br /> I ' URINAL ' METAL FIREPLY�CE&CHIMNEY ' _ <br /> � DRINKING FOUNTAIN � FIREPLACE II�SERT � <br /> ) FLOOR DRAIN � HEAT PUMP ' <br /> i BACKFLOW PReVENTERS i GAS PIPING i <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> ' S�NK(SEFVICE—BAR,ETC.) ; � <br /> � <br /> i � <br /> , i <br /> � � <br /> i � <br /> i � <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> � <br /> PEFMIT $ � PERMIT $ � <br /> , TOTAL FEE $ ' TOTAL FEE $ ' <br /> i <br /> ' FflONT SETBACK REAR SETBACN SIOE SETBACR PLAN CHECK NUMAER FEE RECEIPT NO. <br /> usezor+e �o7nR� vncarrTsite FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING . ' <br /> riPE�FCOHStPItOWABLE lYPEOFCONSt.AC7UAL acuvuav xa.orowElux0uxrt5 � <br /> GP0°v pLUM81NG i <br /> SIZEOFBLO(3. NO.OFSTORIES BASEMENT � <br /> MECHANICAL ' <br /> ❑ YES ❑ NO � <br /> OCCUPANCYLOAD FIqESPHNKLER5NE0'D HEIGHTLIMITAIION OTHER � <br /> ' ' ❑ YES ❑ NO STATEBUILDINGSURCHARGE i <br /> flEA50N FOH SPRINKLEflS <br /> � S7ATEENERGYSURCHARGE i <br /> APPIICATIONACC.BV PLANSAPPROVEDBY CITYOFEVEflETT PU6LICWORKS i <br /> LOCAL SALES , <br /> i TAX COOE IS 3105 TOTA� ' <br /> 1 <br />