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APPLIC�ir'IOI�i FOl� �ONSTRIi.;TION <br />PERI�AIT <br />fhe Ever9rean <br />qTY OF everett <br />everett � <br />BUILDING DEPAR�MENT <br />259 aeio T� BE CQMPLETED IN INK— PLEASE PRINT <br />OWNER NAILAODR[55 �.ITY ZIP PMONE <br />:T9r��sssH���'r r�o�tux ��v� rm4�ysvi��� 9.sa��� 3��� ���.� <br />TENANT MRILAODRE55 GIT'� ZIP PHONE <br />�RCHITECTORDESIGNER MAILA�DRESS CiTY ZiP PMONE <br />GENERALGONTRAGTOR MAILFDpqE35 <br />PLUMBINGCONTRAf,TOR IAAILAO�RE55 <br />NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ D[MOLITION ❑ WOOGSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br />CONTRACi PRICE OF WOPK <br />LOT� BLOGK OF <br />PLUMBING <br />NO, TYAE OF FIX' <br />r '�.4TERCLOSETITOILE <br />.0 f3ATHTUB <br />3 LAVATORY(WASH BASI <br />3HOWER <br />� KITCHEN SINKS DISP. <br />/ DISHWNSHER <br />LAUNDRYTRAY <br />/ CLOTHES WASHER <br />OR ITEM <br />— RAINLEADERS <br />_ aea crr� <br />TOLtL 5 I C�C I— <br />TOTAL FEE <br />FFONTSETBACK REARSEfB�ACgN <br />Zo � /23� � <br />USEZON LOtAFER <br />�Z -Z // <br />TYPEOF6Cv5T. OCCUP NGYGROI <br />�LLOWABLE/ALi:4� I � I� <br />V <br />,iI�E���OGS� � NO.OF TOFiES <br />S � <br />fINESPRINKLER5RE0UIRE0 ❑YES �Q <br />ov <br />5��. �- <br />�-�. <br />5 <br />SIDE3ETBAGK <br />S� <br />VACANT SITE <br />ES ❑ NO <br />NO.OF DWELLII <br />� <br />MT. OCC.LOAD <br />Y <br />N <br />HEIGHT LIMITAT <br />ZgI <br />0 <br />I HEf7EBV CERTIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICA710N AN D <br />KNOW'"HESAMETOBETRUEANDCORRECT.ALLPFOVISIONSOFLAWSAND <br />ORDINANCES GOVERNING TIilS NPE OF WORK WILL BE COMPLETED WITH <br />WH ETHER SPECIFIED HEREIN OR NOT. THE GRAN7ING OFA PERMIT DOES NOT <br />PRESUME TO GIVE �UTNORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT � AM AUTHORIZED BY THE ONiNER OF <br />T:iIS PFOPERTYTO PERFORM THE WORK FOR WHICH APPLICAT�ON IS MADE <br />AND I COMPLY WITH THE STASE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC./� <br />SIGNATUREOFCPNTRAGiORO1S\O OPoZEOAGENT DATE <br />� <br />Ii <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS— H.P. <br />FORCED PIR SYSTEMS— B.T.J. M EA <br />UNIT HEATERS— B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN �% <br />RANGEHOOD ' <br />WATER HEATER <br />WOOD STOVE <br />� METALFIREPlACEBCHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />FAN <br />SUBTOTAL 5 <br />PERMIT S <br />TO7AL FF_E 5 <br />FE� NE <br />VALUATION <br />BUILOING <br />PLUMBING <br />MECHANICA� <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />70TAL <br />FEE <br />�o <br />FEE <br />