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APPLICATIO.. FOR CONSTRUCTI.dN PERMIT 1VeEP« <br />the EKewr,n , TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT HEATING SYSTEM: LAGAS Ll ELECTRIC <br />259-8810 <br />DEMOLITION COMBINATION BUDDING MECHANICAL PLUMBING SIGN <br />211EI/7 MAIL ADDRESS CITY ZIP PHONE q <br />TENANT � &foleq II ADDRESS CITY <br />Newa& CITY L",& li%s'A PHONE32 ?613 <br />ARCHITECJ OR DESIGNER MAIL ADDRESS CITY ZIP PHONE L( <br />GENERAL C NTRACTOR MAIL ADDRESS T CITY ZIP PHONE LICENSE/ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />CLASS OF WORK <br />. NEW ADDITION <br />ALTERATION <br />REPAIR DEMOLITION WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />CONTRACT PRICE OF WORK a too «J J�/�/'� <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WQRK AND SQUARE FOOTAGE INVQLVED <br />_ <br />PROPOSED USE OF UILDING A <br />I HEREBY 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCR ION OF PROPERTY ISI,O BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />'{• <br />Z )�iv <br />e <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AiHNDLG UNITS—H.P. <br />DATHTUB <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 />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />T <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />S G(� <br />�pZ �00 <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OCCUPANCY <br />cawv <br />Na aF Bw[uixc uxrts <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />�D <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />�/ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />l s <br />