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r <br />rr.p e Irw^e^� <br />CnYOF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLIC.-.TION FOR CONSTR�,CTION <br />PERMIT <br />11 <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />1RC55 A CITY <br />MECHANICAL CONTRACTOR MAIL ADUHL56 <br />PLUMBING CONTRACTOR MAIL ADDR[SS GTY SIP PHONE LICENSE <br />I <br />f1 IMRPRT n RI DI DING RELOCATION <br />❑ NEW ❑ ADDITION ❑ ALTERATION HtFAIH u <br />TENANT IMPROVEMENTORINTER EMODE1 1LY ,L <br />CONTI KCTPRICEOFWORK <br />DESCRIBE WORK AND WI,AIPT,FOOT GE lV D <br />c/C <br />PROPOSED USE OF BUILDING 6 <br />N� <br />CONTACT PERSON AND PHONE o <br />/-O O 'J a <br />✓/ 7� <br />%D oB) �� <br />AY�/� I J, %lc e %%a a / a/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPE'IFIEDHEREINORNOi.THEGRANTING OFAPERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER 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 1827 RCW AND <br />0 WAC. <br />GIONATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />SIGNATURE <br />A� <br />LEGAL f-WpnON PROPERTYISH NBELOW OR ATTAON FO wPlEsl <br />/� <br />LOT1I✓�>2 BLOLK_4Il OF <br />dye 1.J <br />4' <br />JD�O�_ OH <br />G(,� f <br />J�J/O <br />PRO/J)EC'ADDRC55 // <br />/ 7 <br />AopLICANLS Pi USINESSL ENSE NO AND BUSMESSNAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />FEE <br />NO. <br />__ <br />_ <br />_ <br />TYPE OF EQUIPMENT <br />UNITS - HP. <br />FEE <br />FORCED AIR SYSTEMS- flT.U. M EA <br />FORCED AIR SYSTEMS <br />_ <br />BATHTUB <br />UNIT HEATERS -flT.U. M <br />LAVATORY (WASH BASIN <br />CLOTHES DRYERS <br />SHOWER <br />_ <br />VENTILATION FAN <br />RANGE HOOD <br />KITCHEN SINKB DISP. <br />_ <br />DISHWASHER <br />_ <br />- - <br />WATER HEATER <br />LAUNDRYTRAY <br />_-- <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />-- <br />FIREPLPCEINSERT <br />HEAT PUMP <br />GAS PIPING <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR. ETC-1 <br />FRONT SETBACK <br />SUBTOTAL <br />PERMIT <br />S <br />S <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE 5 <br />PLAN CHECKN MBER FEE S RECEIPT7 <br />� � O I C <br />TOTAL FEE S <br />REAR SETBACK $IDESETBALK <br />USEZONE <br />LOT AREA <br />VACANT 51TE <br />O YES x NO <br />FEE <br />VALUATION <br />FEfi-iJ <br />BUILDING <br />PLUMBING <br />� <br />It <br />TYPEOFEONST. <br />ALLOWABLE/ACTUAf 5- <br />OCCUPANCY CROUP <br />NO.OF DWELLING UNITS <br />SIZEOFBLDG. <br />NOOF $TORIES✓ <br />FWMT. <br />DEC LOAD <br />MECHANICAL <br />— <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES O <br />HEIOHTLIMITATION <br />IvA <br />STATE BUILDING SURCHARGE <br />L_ <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />1PPLICAnONyACC W PLANS APPR. BY <br />M W\ I /, <br />TOTAL <br />