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APPLICATION FOR CONSTRUCTIuN PERMIT eveTett <br />Ble Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />Cm OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259.8810 <br />1-1 DEMOLITION f I COMBINATION I I BUILDING I I MECHANICAL W-PILUMBING I] SIGN <br />OWNER Al MAIL ADORES$ / p CITY ZIP PHONE <br />�y��e ,4;vic 3`i0i T Nve• F�r����I ?Q0/ �_4 /y L 2, <br />TENANT MAIL ADDRESS v CITY ZIP PHONE <br />0a Te _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRA TOR MAIL ADDRESS ��,,// CITY ZIP PHONE LICENSER <br />i // l 4J/ l r .m v4J. _ ,7,- dl 1-'/ . i a c,^ en :-nty-/ Aer)P Dhf7inn, <br />CL SSOFWORK <br />lV V <br />1' EW ❑ ADDITION VALTERATION Cl REPAIR DEMOLITION ❑ WOOD9TOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHO'IE NO <br />DESCRIBE WORK AND SOVARE FOOTAGE INVOLVED <br />OPOSED USE OF BU ING <br />I HEREBY CERTIFY THAT I HA`,E 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 />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY'i0 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE. WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 ROW AND 296.200 WAC. <br />SIGNATURE OF CONR CTORO A ❑/ORIZEDAGENT DATE <br />x <br />LEGAL DESCRIPTION OFP ERTY(SHOWN BE OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />nn <br />ve b✓ fit— <br />PROJECT ADDRESS <br />PPl AlCRY B 1 6tNESS LICENSE NO. AND USINESS NAME <br />PLUMBING <br />M HANICAL _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />TYPE OF EOUIPMF.i.7 <br />FEE <br />WATER CLOSET (TOILET) <br />9ATHTUB <br />Q 1 -- <br />' <br />A/C—lvHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I. <br />UNIT HEATERS—S.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />' <br />—�T <br />DISHWASHER <br />I <br />RANGE HOOD -- <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING ---— <br />' <br />ROOF ORAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />I <br />SUBTOTAL $ <br />Q i <br />SUBTOTAL $ <br />PERMIT $ <br />/d ' <br />PERMIT _ S <br />TOTAL FEE $1 <br />lzd' i <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USE ZONE <br />LOT AREA <br />TYPE OF CONTS. ALLOWABiF <br />TYPE OF CONST A( <br />SIZE OF BLDG. <br />NO. OF STORIES <br />OCCUPANCY LOAD <br />FIRE SPRNKLER <br />INTAKE BY I PLANSAPPROVEDBY <br />I <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />VACANT SITE FEES <br />VALUATION <br />I-EE , <br />� <br />BUILDING <br />I <br />eCL11GANCT HO gp'NFIIING UN115 <br />I <br />LAWP PLUMBING <br />T <br />I <br />1 ' <br />_ <br />BASEMENT MECHANICAL <br />I <br />i I <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />1 <br />TI <br />OTHER <br />ff <br />STATE BUILDING SURCHARGE <br />I f <br />CITY OF EVERE17 PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />iid <br />