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APPLICATIL A FOR CONSTRUCT i ON PER � { <br />everett <br />ttw rmrgwn CITY OF <br />everettue <br />BUILDING DEPARTMENT <br />� TO BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 <br />❑j DE,/)MOI�LITIIOO�N( -� COMBINATION / / I�BU/ILL/�DI�N/G xMFr.HnNICAL PLUMBING SIGN <br />OMER eA 1 111 I -IM7 $5� I � I�� l• Wf /�.IT Y <br />TENANT MAIL ADORES)$ filry <br />ARCHRECT OR DES13NER MAIL ADDRESS CITY ZIP PHONG <br />MECHANICAL NTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSES <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE S <br />CLASSOF WORK <br />� nITInM i� AI TCOATInM i REPAIR F DEMOLITION .-1 WOODSTOVE/FRPL INSERT ❑ BU LDING RELOCATION <br />1—.1 —...,....._.-— ._. _ <br />TENANT IMPROVEMEN1YTOPNTERI R-ON <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF ORKI / <br />WORK AND OWRE FOOTAGE INVOIV <br />TD—E.SC,,RIBE <br />L Atl I iP l (J i1 LULn �1 <br />d� <br />PROPOSED�SF or�@uILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />GJ/F,T <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 HE"'.EIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOC', OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVF <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 />PRQ EC <br />/� <br />APPLICANTS CITY BUSINESS LICENSE NO. ANU BUSINESS NAME <br />l/ <br />PLUMBING uL <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 />I <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />i <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <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 />' <br />META) FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />' <br />I <br />' <br />SUB TOTAL <br />$ <br />i <br />SUB TOTAL $ <br />—45 11 <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />1 <br />TOTAL FEE <br />$ <br />' <br />TOTALFEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />❑ YES ❑ NO <br />TYPE Oi CONST ALLOWABLE <br />TYPE OF CONA. ACTUAL' <br />Bgp1° <br />rro aurTUINC UNR3 <br />PLUMBING <br />SIZE OF BL00. <br />NO.OF STORIES <br />BASEMENT <br />MECHANICAL <br />5Q iCrPJ <br />❑ YES Cl NO <br />OTHER <br />' <br />OCCUPANCY LOAD FIRE SPRNKLERS REG'D <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />I <br />' <br />G' YES ❑ NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />I <br />� <br />APPLICATION ACC, BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PU13LICWORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />