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APPLICKCION FOR CONSTR6:'.TION <br />PERMIT <br />TRe ETrorpreen PYPrcll <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER r,l MAIL /'- ;s <br />P PRONE <br />CH, TII', <br />'P•(3• 1107 E-VEi.rTT,WR• 9820(o <br />347.4382 <br />'P,1,•�, 1•Lo,1 pF <br />JtbHOM .AUNTY <br />UOX <br />TENANT <br />MAIL ESS ----- <br />CRY <br />ZIP <br />--- PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />Otv <br />TIP <br />PHONE <br />LICENSE • <br />DEWLAZIBOZ <br />MAIL ADDRESS <br />T -„1Nc. 693Z <br />L.OI :� <br />CITY <br />LRRIMR %. <br />E: <br />ZIP <br />EVEFE:TT <br />PHONE <br />98208 337-G799 <br />DENERAL CONTRADTOR <br />I <br />I)fiLL AJOHNSON <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PRONE <br />LICENSE r <br />LICENSE <br />PLUMBINOCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />4 <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR IJ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CON TRACT PRICE Or WORK <br />CONTACT PERSON AND PHONE NO <br />' <br />ARGARET t'1(iR�34�- 43�Z <br />DESCRIBE WORK AND SOUARE I. JPIGE INVOLVED <br />DiJROL1TlON- S•F.•RESID G.NCB. Q <br />GRRAGE <br />j5POSED USE OF BUILDING <br />SITE ZD bE USED FnR ZRHNSfAt5510N LINE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAMETO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LCCAL LAWREGULATING CONSTRUCTION ORTHE PER. <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH TIIE STATE CONTRACTORS LAW 18.27 RCW AND <br />WAG3/2fl/89 296.20 WA <br />0 RE Of CONTRACtOR OR bIiIIORNEp AGENT DATE <br />SIGNATURE <br />X <br />LEGAL —DESCRIPTION OF PROPERTY ISNOWN BELOW OR ATTACH roue COPIES) <br />^� <br />t .y �EvcRLY 1"IARI{ <br />LOT BLOCK OF <br />PIIGACTADDRESS <br />77OI GRANT OR IVE <br />APPLICANTG ITY U NESFUCENSENO AND BUSINESS NAME <br />�• oa SNO OMIS OLINTY <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —_A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— BT.U. M EA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK III DISP. <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 />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />— <br />PERMIT <br />5 <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEL $ <br />PUN CHECK NUMBER FEE RECEIPT NO. <br />FRONT SETBACK <br />REAR SET BACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT snE <br />❑ YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />TYPE OF CONST. <br />ALLO YABLEJACTUAL <br />OCCUPANCYGROUP <br />NO OF DWELLMGUNITS <br />PLUMBING <br />--- <br />_ <br />SIZE OF BLDG. <br />NO. Uf STORIES <br />P�H2 <br />ON <br />OCGI.OAO <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />HEIGIITLIAIIIDt10N <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANSAPPR BV <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />