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APPLICATION FOR CONSTRUCi.ON PERMIT <br />everett <br />TAP Eregrenn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />1 DEMOLITION ❑ COMBINATION c BUILDING MECHANICAL C.: PLUMBING a SIGN <br />MAy.9E55 PHONE <br />•yil4 - 17aT* EL " -3 / —7 Lf' at Y a <br />TENANT M1..BESS CRY ZIP PHONE <br />ARCHITECT OR DESIGNER MAKLADDRESS CITY ZIP PHONE <br />GENERA) LpIT iOR MA <br />•:Nr-55 CITY ZIP PHONE LICENSE• <br />�5ne�c j� „tE.3'1f-ISdtQS) �,1YNv1csr���l1 —lvz-is1� S�FLICENSE•CENSES l36�1� <br />MECNANICK Cp11RACTOR MAK ADOR[55 CITY ZIPIP PHONE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PWNE LICENSE. <br />7 <br />—., r I —.- F, .O.-InM I' GPPAIR - nFMnI ITION F I WMDSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT ORIMERIOH EMOOF}CNLY <br />CONTRACT PRICE CF WORK: <br />CONTACT PERSON ADD PHOW: NO. <br />O RIBS W9G «AND �RE(pFACE IIVCLVEO <br />Uu\q I <br />PROPOSED USE <br />r G <br />HEREBY CEFIBu\gp4i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION FAD 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 SRECIFIED 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 WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1S27 RCW AND 296.200 WAC. <br />'FGNATUPEO RRACTOR OR AA�MUUT�HIC�)RR�IZEDAGENT DATE <br />LEGAL DESCAPTION OF PROPS ISHOWN BELOW DR ATTACN FGUN CDPILSI <br />LOT BLOCK OF <br />PROTECTADDRESS <br />130.5 _� 1 _ �i <br />` <br />- 1}I• <br />W 1 L <br />APPLICANTS CITY HUSHES$ LICNSE 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 />WATER CLOSET (TOILET) <br />NC—AHNDLG 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 />SHOWER <br />CLOTHES DRYERS _ <br />KITCHEN SINK 8 DIED <br />VENTILATION FAN _ <br />DISHWASHER <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 />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />�T <br />ROOF DRAINS--RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT S <br />airig <br />TOTAL FEE <br />$ <br />1 <br />TOTAL FEE S <br />FPONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO <br />USE ZONE <br />LOTAREA <br />vADANi NTE <br />❑ YES G NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONS) ALMMAE <br />TYPE Or CONST ACNAL <br />O.DMKY <br />RIOLMIIInc ma's <br />PLUMBING <br />SMEOFBLDG. <br />NO Of STORIES <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />' C <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS RED O <br />i i YES C NO <br />REASON FOR SPRINKLERS <br />HEIGIRLWRATpN <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />I'IANSAPPROVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />653 <br />