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APPLICAw'ION FOR CONSTRL ;TION <br />the EYerpreen PERMIT <br />CITY OF <br />everett YITP" <br />BUILDING DEPARTMENT e <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY <br />ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS OITY <br />ZIP PHONE (//'�� LICE/NS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY — K- KC�R-SEE A <br />Lo <br />�yv1` I,-Volc - C//{{�� ALOD--) L ^N NLA )tC� ZIP �PHONE <br />ICENSE <br />Cy�}P., XL • <br />Cl NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR I -I nrunl lrinu fl ...____ r� <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />- -- <br />--••••- <br />•-• .,. ,,wvvrnn_INSER IJ BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOLAR FOOTAGE INVOLVED <br />1 <br />PR US OF B ILDING n <br />/ r/I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAPPLICATION AND <br />l..'U <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED <br />LEGAL DES RI 1 0 TY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES <br />LOT BLOCK OF <br />NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS <br />OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESB <br />•••CAN I I Y TTUbINEbS LICENSE NI,. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTII'E OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/H NOLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />LAVATORY <br />LBASIN) <br />UNIT HEATERS-B.T.U. M <br />SHHOWEOWE R <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISR <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER 1,77w7 (jj tL <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 />ROOF DRAINS - RAI NLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />S <br />SUB TOTAL g <br />PERMIT <br />PERMIT S <br />FRONT SETBACK <br />TOTAL FEE <br />REAR SETIV^K <br />$ <br />SIDE SETBACK <br />TOTAL <br />PUN CHECK NUMBER <br />FEE <br />FEE <br />$ <br />RECEI"NO. <br />US —ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />O YES ❑ NO <br />VALUATION <br />FEE <br />BUILDING <br />TYPEOFCONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCVGROUP <br />NO. OFDWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES SSMT <br />OCG lOAO <br />OY <br />DN <br />MECHANICAL <br />�f <br />�h <br />J <br />HEIGHT LIMITATION <br />OTHER <br />FIRE SPRINKLERS REQUIRED C YES D NO <br />STATE BUILDING SURCHARGE <br />-- <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BV PLANS APPR DV <br />PUBLIC WORKS <br />_ <br />TOTAL <br />