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aH <br />pax <br />C H <br />>Hm <br />tH"�3 <br />K ZZ C] <br />H <br />om0 <br />itHIV <br />H <br />�T. rnH�+ <br />i*1 O P <br />1-3 C <br />OH <br />H Q <br />zH <br />H <br />HH <br />gEn <br />H <br />ot7ti <br />z H rn <br />Horn <br />APPLICATRoN FOR CONSTRUCToON PERMIT <br />1110 Evergreen OV Cl of l <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO UE COMPLETED IN INK —PLEASE PRINT <br />I I DEMOLITION I I COMBINATION 1G BUILDING I MECHANICAL IX PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY 711, PHONE <br />ritst PresbvLerian Church of EvereLL, 2936 Rockefeller Ave, Everett, WA 259-7139 _ <br />TENANT MAIL ADDRESS CITY ZIP PIIGNE <br />ARC141TECT On DESIGNER MAR ADDRESS CITY TIP PHONE <br />PCMblcolm Campbell & AssociaLes. 19660-10tlt Ave NE PaTlstn WA 98370 779-2249 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Ceorae Newland Construction, P.O. Box 958, Everett WA 98206 259-9191 _NBAA343LO <br />MECHANICAL COUIRACTOR MAIL ADDRESS CITY 71P PHONE LICENSE <br />PLUMDINGCOIITnACIOR MAIL ADDRESS CITY III, I`IKNd LICENSED <br />CLASSOF WORK <br />I I NEW I l ADDITION j(I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I l BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERNI�Rr,R�EMODEL ONLY <br />CONTRACTPRICEOF WORN: $60,D30,00 estInEtteTl <br />CONTACT PERSON AND PHONE NO <br />_ rtticGlm Combell of WA (2%) 779-2M9 <br />DESCRIBE WOnK AND SQUARE FOOTAGE INVOLVED <br />OtivTcel Renovation 2,357 s.f. <br />PROPOSED USE OF BUILDING <br />(burch SmIctuary <br />I HEREBY CERTIFY THAT 1 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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 1 COMPLY WITI4 THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />SIGNATIn1E (T CONIRACTOR On AUT 'IZED AGENT DATE <br />)((0 -'1-10 <br />LEGAL DESOnIPHON OF PRGPERTY ISHOWN BELOWOR ATTACH FOUR CYRNESI <br />LOT_ BLOCK of <br />- <br />PROJECTADDRESS <br />29_ Rockefeller Avenue Everett WA <br />APFYIG•.NTS CITY DITSIIRSS LICENSE 140 AND mTSMSSNAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM, <br />-FEE <br />NO. <br />TYPE OF EQUIPMENT <br />F <br />_ <br />WATER CLOSET (TOILET) <br />I <br />MCrNHNOLG UNITS-H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A <br />' <br />LAVATORY (WASH BASIN) <br />_ <br />30 ! OD <br />UNIT HEATERS-B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8CHIMNEY <br />_ <br />DRINKING FOU IN <br />I <br />FIREPLACE INSE <br />; <br />FLOOR DRAI <br />�— <br />HEAT PUMP <br />�— <br />BACKFLgKPREVENTERS <br />GAS PIPIN <br />_ <br />ROO RAINS-RAINLEADERS <br />I <br />EXHAUS AN <br />SI K (SERVICE -BAR. ETC.) <br />I <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />MOD <br />PERMIT $TOTAL <br />FEE <br />S <br />TOTAL FEE $ <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CIJECK 1411WER TEE ,7 FF.L 5( <br />d $ 301.60 <br />RECEIPT NO. <br />usEzoNE <br />LOT AREA <br />VACANT SITE <br />I I YES IX NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />Y <br />s �'om•� <br />` <br />TYPE OF CONST ALLOWABLE <br />V - 1 <br />TYPE Or CONSI ACTUAL <br />V - 1 <br />B[OA'ANCr <br />A2.1 <br />MaPM1lNBUKTs <br />- - - - - - <br />PLUMBINGUL V � <br />, <br />SVEOFOLDG. <br />lEY 1 d T �• <br />NO OF STORIES <br />2 <br />BASEMENT <br />IX YES 1.1 NO <br />MECIIANICAL <br />- - -- <br />OTHER <br />_ <br />Qm m_ <br />- Z rsls= <br />OCCUPANCY LOAD FIRE SPRNKLEns REDD <br />1 ` <br />Q le, OYES 'IX\ NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />Terre'. <br />STATE ENERGY SURCHARGE <br />�— <br />� <br />APPLICATIONACC. BY <br />PLANS APPROVED BY <br />4l <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />`61i-;06 <br />'ib/. 0 1( <br />