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APPLICATION FOR CONSTRUCTN PERMIT <br />�� everett <br />L'AP Evxyrwn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ^G BUILDINGCANICAL [—I PLUMBING ❑ SIGN <br />�MA 110 /A DTVimI /t MyP10n0 0 `Z-0 1 — //� /0 <br />T;H ^ _ /i MAIL ADDRESS ' ( CITY ZIP , PHONE <br />ARCHITECT OR DESIGNER �/ MAIL ADDRESS v CITY ZIP PHONE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />TENANT IMPROVEMENT OR INTE))F <br />CONTRACT PRICE OF WORK: /, <br />-RATION 1-1 REPAIR I 1 DEMOLITION I. 1 WOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />PROPOSED USE OF BUILDING�,L <br />�l <br />1 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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK _ OF <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 />jOXNATURLONTRaCTOR ORAUTHORIZEDAGENT DATE <br />- <br />PROJECT ADDRESS <br />APPLI ANTS CITY BUSINESS VENSE NO. AND ESS NAME <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 />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) _ <br />_ <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHESDRYERS <br />�- <br />KITCHEN SINK 8 DISP <br />VENTILAFION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE $ CHIMNEY <br />, <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />F <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />3a <br />PERMIT $ <br />, <br />_ <br />PERMIT $ <br />�1 ; <br />TOTAL FEE $ <br />TOTAL FEE $ <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 />❑ YES ❑ NO <br />BUILDING <br />T— <br />TYPE OFCONST.ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OMUTANCr <br />400F IGINcuYrtS <br />PLUMPING <br />GBWB <br />I <br />SIZE OF BLDG. <br />NO.OF STORIES <br />BASEMENT <br />MECHANICAL <br />, <br />❑ YES L1 NO <br />OCCUPANCYLOAD FIRE SPRNKLFRS REO'D HEIGHT LIMITATION <br />OTHER <br />Ll YES 11 NO <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRINKLERS <br />_ <br />STALE ENERGY SURCHARGE <br />--T <br />; <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />;Qv <br />TAX CODE IS 3105 <br />