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APPLICATION FOR CONSTRUCTIviN PERMIT <br />tho everett <br />EYeryleen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING XWECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />_-....._ „Ail Annnw CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />A CITY <br />ZIP <br />PHONE <br />GENERAL M AD�XRESS <br />CRY <br />ZIPRACiOP <br />PHONE <br />E LICENS <br />InlE�� <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />(�1�2iT M&--H 0/kIsa" <br />&I& N4 r2,61m,r <br />o 92o52- <br />883-92z� <br />zelov <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE t <br />CUSS OF WORK <br />❑ NEW ❑ <br />XALTERATION ElREPAIR Ll DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR IWEELRR�I--O--R�/�PP� ONLY <br />CONTACT PERSON AND PHONE NO, <br />�40DEL <br />CONTRACT PRICE OF WORK. (S /L_-L) C>"i <br />DESCRIBE WORK AN" SCUARE FOOTAGE INVOLVED <br />-714 <br />Q <br />PROPOSED USE Or BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />Nn1r r <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPER TY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK _ OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO 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 I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE CONTR TOR OR AUTHORIZED AGENT DATE <br />-723yI1 <br />— <br />�(--T 32!�, I L '—`� , <br />PROJECTADORE SS <br />APPLICANTS C'TY BUSINESS LICENSE NO. AND BUSINESS NAME — <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />T— <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />T <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />! <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />E) AUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />I <br />T <br />1 <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />FJ O <br />PERMIT <br />$ <br />PERMIT $ <br />1 ' <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />O <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />❑ YES ❑ NO <br />TYPE OF CONST. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />ImPANLY <br />GR" <br />NO IZ OM[MUN UBBs <br />PLUMBING <br />SIZE OF BLDG, <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS READ <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />' <br />— — <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />