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APPLICATION FOR CONSTRUCTION <br />/ PERMIT <br />fM fwFprsen <br />CITY OF PvereU <br />everett e <br />BUILDING DEPARTMENT <br />225.9.8810 TOO�BE COMPLETED IN INK- PLEASE PRINT <br />I�nMA=L ADl�15iTY ZIP � S�PHONE � �( <br />PHONE L�IGEN9E _ <br />CLABB OF WORK <br />— .--. _. ___.__.. t1 ___.... f1 Fl wnnnemverrool luccot n BUILDING RELOCATION <br />TENANTIM OVEMENTORIKMRI REMOOOEILONLY <br />CONTACT PERSON AND PHONE NO <br />: <br />CONTRACT MICE OF WORK J .0) <br />_ <br />DA�CMBE PORK ANDB� E AGE INVOIVEU ��� � I <br />1�'J <br />POSED USE OF BUILDING/_\WI, /�^:'LL- <br />PRO1Uo <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WH ETH E R SPECI FI E D H EREI N OR NOT. TH E GRANTI NG OF A PERMIT DOES NOT <br />LEGAL DESCRIPTK)NLIFPROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BLOCS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />LOT <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 1 COMPLY WITH THE STATE CONTRACTORS LAN 1827 RCW AND <br />296.20U WAG <br />SIGN URE OF CONTRACTOR ON AUTHORI MAA�GGEENT DATE <br />PROIECi AODIIEY I .-� 1 I <br />b/) <br />APPLICMMCITYBUSINV S LICENSE NO AND BUdNEBE 1UME <br />FAMWBINQ <br />MECHANICAL <br />jp <br />TM OF FIXTm OR REM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NNTER CLOSET (TOILE) <br />NC — A/HNOLG UNITS — H.P. <br />FORCED AIR SYSTEMS— 8T. EA <br />BATHTUB <br />LAVATORY (WASH BASIN <br />UNIT HEATERS—BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACEA CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />HEAT PUMP <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />S <br />SUBTOTAL S <br />U <br />SUBTOTAL <br />S <br />S <br />PERMIT $ <br />PERMIT <br />TOTAL FEE S <br />TOTAL FEE S <br />FRONT SET BACK REAR SETBACK SIDE SETBACK <br />PLAN CHECK NUMBER FEE R[CEIPT NO. <br />uSEZONE <br />LOT <br />VACANTSRE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TVPEOFCONST. <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />ALLOWABLVAC➢AL <br />PLUMBING <br />SIZEOFBLOG <br />NO OF STORIES <br />ESMT, <br />OCC.LOAD <br />MECHANICAL <br />a <br />OTHER <br />❑N <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />— <br />FIRE SPRINKLERS REQUIRED ❑ YES IT NO <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICATION ACC EY PLANS APPR BY <br />s- <br />�� <br />TOTAL <br />.5 <br />