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I <br />AF'PLICATIO FOR CONSTRUCT113N PERMIT <br />1 NK,Ere��eB everett. <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PL ASE PRINT <br />❑ DEMOLITION I COMBINATION I BUILDING CHANICAL I I PLUMBING I I SIGN <br />Efl AILAODRESS -wG— 21P PHONES`— <br />T MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />MAIL <br />CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />❑ NEW I I ADDITION XaERATION REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR IlNff iLR�jl-`j�111� <br />CONTRACT PRICE OF WORK: FJ,-iYU <br />S,1`4L•JY SV <br />CONTACT PERSON AND PHONE NO. <br />A WARE FOC AG INVOLVE <br />D USE OrB DING, DOSE DING�I <br />HEREBY CERTIFY THATHEREBY 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 WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />IAGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X �`— <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK _ OF <br />P CTADDRESS <br />API (CANTS CITY BUSINES LICENSE NO A BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO=_ TYPE OF FIXTURE OR ITEM <br />i <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />VATER CLOSET (TOILET) <br />A/C-/VHNOLG UNITS--H.P. <br />, <br />HATHTUB <br />FORCED AIR SYSTEMS-B.T.J. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />; <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />; <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS-RA!NLEADERS-_ <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />, <br />F <br />I <br />--� <br />-- <br />I <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $- <br />PERMIT $ <br />--T <br />_ <br />_ _ <br />PERMIT $ <br />/E ; <br />TOTAL FEE $ <br />FEE $ <br />TOTAL FEE <br />TOTAL FEE $$ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />_ <br />LOT AREA <br />VACANT SITE <br />I I YES I I NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CDNST ALLOWABLE <br />TYPE OF CDNST. ACTUAL <br />occuraNcr <br />Bwr <br />I NOW Dwrium UNITS <br />PLUMBING <br />I <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />I I YES I I NO <br />MECHANICAL <br />,- ; <br />--- <br />OTHER <br />- <br />; <br />OCCUPANCY LOAD FIRE SPRINKLERS REO11 HEIGHT LIMITATION <br />I I YES I I NO <br />REASON FOR SPRINKLERS <br />STATE BUII DING SLI63HARGE <br />STATE ENERGY SIIHCHARGE <br />� <br />; <br />APPLICATI:N ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 1 <br />PUBLIC WORKS <br />TOTAL <br />J— <br />irlr <br />