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APPLICATION FOR CONSTRUCTION PERMIT everett <br />the EYP,Q,PPR TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett BUILDING DEPARTMENTHEATING SYSTEM: ❑ GAS j ELECTRIC ❑ _ <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL ; 4LUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Ju- <br />— 1 Z l <br />TENANT 0 <br />dlAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />Q_ <br />MEC ANI AL COlfRACTOR MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />FQrj PCu nY <br />CLASS OF WORK <br />. NEW ADDITION ALTERATION XREPAIR <br />CITY ZIP PHONE LICENSER <br />eag n . P! 123,90 <br />ZIP PHONE LICENSE i I - 4 _ C' <br />4 S, 3Yl'1 f S <br />DEMOLITION WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <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 /OFFFCOCOOyNFT�RACT�OR ORIFAUTHORIZED AGENT DATE <br />U'�fn C., Y �,' <br />APPLICANTS CITY BU NESS LICENSE NO. AND BUSINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY JSHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLACK of <br />PROJECT ADDRESS - <br />"Z_2-3 lj� Cr ueoec <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <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 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <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—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />—T <br />T <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$1 <br />oll <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 />I FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CDNIS. ALIOWABIE <br />TYPE OFCONST. ACTUAL <br />OCCUPANCYx0 <br />4P00P <br />Of MILLING uxrs <br />PLUMBING <br />- <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS FEET HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />�— <br />STATE BUILDING SURCHARGE <br />- <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODF. IS 3105 <br />PUBLICWORKS <br />TOTAL <br />