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APPLICATION FOR CONSTRUCTN PERMIT <br />everett <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259.8810 <br />Ll DEMOLITION I I COMBINATION UILDING MECHANICAL I PLUMBING SIGN <br />OWNER w nIL AD�ESS CITY ZIP P140a�PHN�-OO <br />"NT AIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />ENERAL CON )RAC TOR IAIL ADDRESS CITY ZIP PHONE LICENSCI <br />(�-, �yAc�a;,��Ca�"53D7—�3ggPf5; rlj 9�2�0 25� 2So6 �(r,cS ACiJfCM <br />MECHANICA DNTRADTG MAILADDRESS p CITY 71P PHCNF LICENSE• <br />�g <br />PI UMBING COAT FLACIOR MAIL ADDRESS CITY _IP PHONE LICENSE <br />CLASS OF WORK I I nv..nl mm" I I wnr)nAtnUFIFRPI INSERT 1 1 BUILDING RELOCATION <br />l�SNhW I I ALIVI null I , `. ..••..— <br />.._...... - _- <br />TENANT IMPROVEMENT OR INTER R�EMO'IDEL ONLY <br />CONTACT PERSON AND PHONE N0, <br />O 00 <br />CONTRACT PRICE OF WORK: �J eC F <br />DESCRIBE WORK AND SOUARE F TAGE INVOLV <br />ING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ROP DUSE Bow <br />Q <br />L(fY{'LiyryLy]Y,.t,Y <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />1P1�.y�o <br />_ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE ,:OMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW OH ATTAUn FOUR COPIES) <br />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK _ <br />AUTHORITY TC VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW RFGULATING 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 WAG. <br />SIGN URE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PPOJECT ADDRESS <br />A"" NTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A'C—NHNDLG UNITS—H.P. <br />AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />_FORCED <br />LAVATORY (WASH BASIN) <br />�— <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />SHOWER <br />KITCHC-N SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />!_ <br />_ <br />WOOD STOVE <br />_ <br />' <br />METAL FIREPLACE & CHIMNEY <br />METAL <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />�— <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />T <br />I <br />I <br />I <br />, <br />I <br />—T <br />I <br />SUBTOTAL <br />$ <br />' <br />SUBTOTAL $ <br />,QO = <br />— <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />/.j T <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />FF ONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />I I YES f 1 NO <br />BUILDING <br />--- <br />' <br />TYPE OFCDNST.ALLDwABLE <br />TYPE OF CONST ACTUAL <br />BLEUPAKY <br />Imp <br />NO UI IANILLINGUNITS <br />-- <br />PLUMBING <br />, <br />T_ <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />- <br />--- <br />p <br />I I YES I I NO <br />OTHER <br />; <br />— <br />OCCUPANCY LOAD FIRE SPRNKLERS RED <br />HLIMITATION <br />I YES I I NO <br />STATE BUILDING SURCHARGE <br />' <br />T <br />STATE ENERGY SURCHARGE <br />— <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY <br />PLANS APPROVED By <br />CITY OF EVERETT <br />PU13LICWORKS <br />�G <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />f ' J <br />