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APPLICATIOWFOR CONSTRUCTIL-A PERMIT everect <br />ma E�PIoJPa^ TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM GAS ❑ELECTRIC U <br />BUILDING DEPARTMENT <br />259.8810 <br />q DEMOLITION COMBINATION i BUILDING I MECHANICAL I i PLUMBING SIGN <br />OWNS MAIL ADDRESS CITY ZIP PHONE <br />Pin <br />MrTv,1. i�«��f ; 4oi anTtiAl/G 5l �I 9�fso a �35'��i9 <br />TENANT MAIL ADDRESS ITy <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />r 1r a, <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR MALL ADDRESS CITY ZIP PHONE LICENSE) <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS OF WORK <br />n .Iow I AnmmnN I AT TPRATION I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />'Jp <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />?H/ ARV 6,¢,vm — u <br />CONTACT PERSON AND PHONE NO <br />— <br />— <br />PROPOSEDUSEOFBUILDING <br />HEREBY CERTIFY THAT I HAVE 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 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 WHK.H <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X I 1I <br />�_Pnn �US �w�. tfOwu-S <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />LEMLDESORIPTIONO PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />P <br />Lor18 1� CLOCK 4 of'L�.rnL.�' D;d — <br />of, i14v,ev ,ze.n/ t15 Ue/ 3 094 b ✓ O <br />pe ---�--7 <br />L,^ <br />PROJECT ADDRESS <br />PLUMBIN <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE . <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />70 ' - <br />A/C-A/HNDLG UNITS-H.P. <br />I <br />BATHTUB _ <br />/� ; _ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />_ <br />LAVATORY (WASH BASIN; <br />i— <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />�� '- <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 9 DISP <br />VENTILATION FAN <br />DISHWASHER <br />" - <br />..ANGE HOOD <br />' <br />.d- <br />LAUNDRY TRAY <br />WATER HEATER <br />' a o <br />CLOTHES WASHER <br />I " <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />i <br />I <br />ti <br />I <br />SUB TOTAL $ <br />flo <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE <br />ono nccinr I I= nul V. <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />yi a4�sF;l <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />�-� <br />3(e t SE <br />I <br />U iOO <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />LKCMVMY AUULLINLummis <br />GA0''P <br />SIZE OF BLDG. <br />NO.OFSTORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRNKLERS REO'D HEIGHT VMITAT&- <br />OTHER <br />i <br />J <br />REASON FOR SPRINKLE' S <br />�— <br />STATE BUILDING SURCHARGE <br />i Sv <br />INTAKE BY <br />PWAAPPROVED <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />/� <br />TAX CODE IS 3105 <br />TOTAL <br />�' 7% <br />