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i <br />APPLICATION FOR CONSTRUC. !ON PERMIT <br />everett <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION I I COMBINATION El BUILDING ❑ MECHANICAL L PLUMBING Ll SiGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />fENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />NERALCONTRAC OR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />P ONE -o675 LICENSEE <br />�wGE // <br />�eCCONTRACTORn-e �DRESS," <br />GS ',,,<///}}}TTL��N� <br />9� <br />L-���e >..�v i'll/.5.� � <br />� F. <br />MECH <br />CITY ZIP 4"4.2He <br />LICENSE• <br />�I <br />J <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSER <br />CLASS OF WORK�,�. <br />❑ NEW Ll ADDITION ❑ ALTERATION <br />'y REPAIR <br />L..l DEMOLITION I.1 WOODSTOVE/FRPL INSERT <br />E: <br />L_l BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODFy01,&Y <br />CONTACT PERSON AND PHONE NO. ` <br />CONTRACT PRICE OF WORK: ff,'J/���CCll����jj <br />— <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />f ee�,4.T a g� 'oo 3�sd' -� leecore� <br />PR OSEDUSEOFBUIL G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />���t <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY ISNOWN BELOW04 ATTACH <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />UOr BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TOGIVE <br />_ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />FERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />- - - <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNAATTUURR( <br />EEOO-FCONTRACTOR OR AUTHORIZED AGENT DATE <br />x <br />JEr,T ADDRESS <br />PROJ <br />APPUCANTSCITY 13USINESSLICE NSENO.AND RUSINE <br />MECHANICAL <br />_PLUMBING <br />NO.WTYPEOFOF <br />FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />T (TOILET) <br />AIC-A/HNDLG UNITS-H.P.FORCED <br />AIR SYSTEMS-B.T.U. M E.A.SH <br />BASIN) <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />& DISP <br />VENTILATION FAN <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING__ <br />_ <br />ROOF DRAINS—RAINLEADERS <br />_—� <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />,— <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FCE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />i <br />L] YES 11 NO <br />TYPE OF CCNSL ALLOWABLE <br />TYPE OF COHSi ACTUAL <br />ctcuvextr <br />c'ouP <br />xO OE O.HumGuxns <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OTHER <br />' <br />L.000PANCY LOAD FIRE SPRNKLERS RED HEIGHT LIMITATION <br />i <br />U YES ❑ NO <br />STATE BUILDING SURCHARGE <br />' <br />REASON FOR FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />' <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />— <br />LOCAL SALES <br />' <br />TAX CODE IS 3105 <br />TOTAL <br />