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th* EargrBsn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269•881O <br />APPLICk fTION FOR CONSTRaTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARCHITECT OR DESIGNER / MAIL ADDRESS CITY ZIP PHONE <br />RL�rnHti'f.�UMqLAppgEyyUUHL 7 <br />UEN MLCONTRACT CITY 21P PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE s�,? N 4C SE <br />...... Fl wnnngTnVP/FRPI INRFRT ❑ BUILDING RELOCATION <br />d ncn <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROKMED USE OF BUILDING w• <br />LJ L.O `„,-e �..L!!L <br />LBCn,IPDO,►NwO0 t.NBELOY/OR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTING OFAP :RMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOL.-9 OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULAI:NG CONSTRUCTION OR TF 'ER, <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWF OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />S40NATAU^/RE OFCONTRACTOROR AUTHORIZEDAGENT DATE8 <br />S G/1 <br />�l x <br />ERfUTTY II'9Rill <br />l[GAL DWE ATTACH FOUR COMES) <br />LO7 BLOCK OF <br />MGJECT ADDRESS <br />W-o lflolanvsadf <br />APPLICANTS CITY BUSINESS LICE NSB NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYFE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLO',ET (TOILE <br />NC — ANHNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />) <br />UNIT HEATERS— B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 6 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 & 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 />_ <br />SINK (SERVICE — BAR. ETC.) <br />CUB TOTAL <br />cc <br />SUBTOTAL E <br />O <br />PERMIT <br />E <br />PERMIT E <br />TOTAL FEE <br />E <br />1 <br />TOTAL FEE 5 <br />FRONT SETBACK <br />SETBACK <br />SIOESETSACK <br />PLANCHECKNUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />[REAR <br />TAREA <br />VACANTSITE <br />❑ YES O NOBUILDING <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />ALLOWABLE/ACTUAL <br />CUPANCY GROUP <br />NO.OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDO. <br />. OF STORIES <br />BSMT. <br />❑Y <br />❑ N <br />OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REI: "D ❑ YES ❑ NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLICWORKS <br />TOTAL <br />