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APPLICIIxi PION FOR CONSTRto TION <br />PERMIT <br />ME EvnVFEER <br />eveTett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT 26"810 TO BE COMPLETED IN INK— PLEASE PRINT <br />ONNIR MAILADDRESS CITY 21P PHONE <br />.. A. • <br />NE <br />ARCHITECT OR DEBIGNER <br />MAIL ADDRESS OITY 21P PHO- <br />GENERAL CONTRACTOR MAIL AODRE95 CITY ZIP PHONE LICENSE• <br />A1B('auCjB-GMG <br />AU�DCO A_4�� 4AILADDRE99 CITY ZIP PHONE LICENSEA <br />N!t CaB.As frsaa h <br />OF N'ORK rT cool I NRCBT ❑ BUILDING RELOCATION <br />p-NEW ❑ ADDITION U ALTERATION U <br />REPAIR Ll UCMVLNIVn <br />CONTACT PERSON AND PHONE NO. <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />DEECIK@ WORKAIDEpUAREFOOTAGE <br />'� �s�:Ae 22le0 SF <br />CERTIFY) HAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />PROPOEEO W [ OF [uILDING <br />I HEREBY <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAN' SAND <br />N�tfF / <br />CM.rti�-� <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETEr, WITH <br />LEGAL DESCRIPTION OF PROPERTY ISMOWN BELON OR ATTACH <br />FOUR COPIESI <br />WHETHER SPECIFIED HEREIN OR NOT.TIIE GRANTINGOFAPERMIT DOES NOT <br />TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OF <br />PRESUME <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />OF <br />LOT BLOCK( <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION ISMADE <br />.A.�..Ai <br />Sept�-'� <br />I SCr• <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1827 ROW AND <br />288200 WAC. <br />SIGNATURE OFCONTRACTOR OR AUTHORIZED DATE T Y <br />y <br />fAal <br />FRMCT ADO <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />DI IN e .s't <br />PWMBING <br />MECHANICAL <br />NO. rim OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />A/C - AVHNDLG UNII S - M.P. <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS- ELT.U. M EA <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />. LAWITORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />( <br />VENTILATION FAN <br />KITCHEN SINK6 DISP. <br />'t <br />DISHWASHER <br />RANGEHOOD <br />- <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />WOODSTOVE <br />77— <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <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 />SUBTOTAL <br />S <br />SUR TOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE E <br />FEE R[CEIR NO. <br />EC UMBER Z_i41 <br />� 3Q a <br />FRONT SETBACK <br />TOTAL FEE <br />REAR SETBACK <br />$ <br />SIDE SETBACK <br />6Ito <br />;PLAN;C <br />�a�l <br />LXIEZONE <br />LOT AREA <br />VACANT SITE <br />rES ❑ NO <br />FEES VALUATION FEE <br />p <br />h' 1 <br />BUILDING <br />PLUMBING <br />TYPE (KCONST. <br />µLOWABLVACTUALy' 14 <br />OCCUPANCYOROUP <br />9.3 <br />NO.OFMElLINOUNITS <br />SIZE OFBLDG. <br />NO. OF STORIES <br />BSMT. <br />❑ Y <br />OCC LOAD <br />NN <br />MECHANICAL <br />2 <br />+ <br />OTHER N <br />2. <br />0 <br />�/ <br />HEIGHT LIM'ITTAA(TION <br />Z <br />FIRE SPRINKLERS REQUIRED ❑ YES 0 <br />" <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICATION ACG BY ?CANS APPR. Y <br />TOTALEEH- <br />I A V � <br />