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APPLICATI00FOR CONSTRUCT& PERMIT everett <br />EMS TO BE COMPLETED IN INK --PLEASE PRINT R puLaEA e <br />CITY OF <br />everett HEATING SYSTEM: GAS 0 ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />"l DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN i <br />ML ADpR[SS CITY ZIP PHONE T <br />iot�za6 ttoAIa 7si3yb121:rr Wp ggdoj <br />14 <br />TENANT <br />MAG. ADDRESS <br />CITY <br />ZIP I I PHONE <br />V <br />II <br />Ap <br />SS <br />MAIL ADDRESS <br />CITY <br />PHONE <br />3 _ <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />21P PHONE <br />LICENSE <br />`T o W& <br />j -+ she f�xN F D <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CI1Y <br />ZIP PHONE <br />LICENSE <br />f <br />ZIP PHONE <br />LICENSEI <br />ALA6MG CONTRACTOR <br />MAIL ADDRESS <br />t <br />II <br />i <br />Y <br />CLASS OF WORK <br />RATION <br />REPAIR .DEMOLITION <br />WOODSTOVE/FRPL INSERT BUILDING RELOCATION 5 <br />NEW L I ADDITION ALTE <br />CONTACT PERSON AND PHONE NO <br />I"`V "'- <br />r'A AT —1504Ts E „7 s&- _)1 1 4- <br />CONTRACT PRICE OF WORK . F/ <br />DESCRIBE WOM AND SOIARE FOOTAGE INVOLVED <br />r q 113 N 6UbZo A4 j4>�ITI <br />— <br />I a <br />PROPOSED USE OFBUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED''HIS <br />/ <br />�/ / <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 09 <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW OR ATTACH FOUN C IEsI <br />A BLOCK_ of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LoT/i <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />S A _r <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 />- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OFCONTRACTORORAUTHORSED AGENT DATE <br />PROJECT ADDRESS y,,p,p _ <br />�/�(/�t •{, <br />17 R T� R .,y �V T <br />w'1 <br />Y` <br />:APPiUClTY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />CHANICAL <br />FEE <br />NO, TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />NC-A/HNDLG UNITS-H.P. <br />BATHTUB <br />' <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 & OISP <br />KI <br />VENTILATION FAN <br />DISHWASHER <br />--� <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) _ <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR <br />i <br />vrna.� vac <br />FRONT SETBACK <br />vn�N. <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CNE NUMBER <br />2 <br />FEE /p <br />RECEIP�OG/ <br />USE LONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I ZO drio <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OCCUPAY <br />GAWP <br />NOOIPAtUINGUNnS <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I (p <br />?i <br />-�� <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHTLIMITATICN <br />Aid <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />^7 <br />INTAKE BY <br />PUNS APPROVED BV <br />evsB. cT - /hl <br />CITY OFEVERETT <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />m <br />