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APPLICATI"' FOR <br />CONSTRUCI;SN PERMIT <br />everett <br />the EYe <br />CITY OFF <br />everett <br />BUILDING DEPARTMENT <br />TO BF. COMPLETED <br />IN INK —PLEASE PRINT <br />259.8810 <br />❑ DEMOLITION C) COMBINATION i i BUILDING MECHANICAL PLUMBING 1 SIGN <br />OWNER MAIL ADDRESS <br />10940 3'"Dr. <br />1►fll�;aM +-F,ilyl <br />CITY 21P PHONE <br />SC &tfttt 4gzog 3'/8-G0 43 <br />t!IT <br />TENANT MAIL ADDRESS <br />CITY 21P PHONE <br />fame- as o3sye- <br />ARCHITECT OR DESIGNER MAIL' `RESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR FRAIL ADDRESS <br />CITY ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSER <br />CUSS OF WORK <br />1., n Ar IllTInAI I AITGRATInN 1 RFPAIR <br />11 DEMOLITION /,-�WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK: <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Uloous?nvE <br />PROPOSED USE OF BUILDING <br />SFQ.. <br />I HEREBY CEPTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AN D 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 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STAT"E 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 />DAAGGGENT DATE <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED <br />LEGALDESCRIP110N OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <br />PROJECT ADDRESS J <br />10910 3DrstP"w_tt <br />gOLO ir <br />NO.BUSINESS NAME <br />APPLICNITSCITYNUSMESS LICENSE <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />&C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />�_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />INSERT <br />—� <br />FLOOR DRAIN <br />_FIREPLACE <br />1EAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />T_ <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />�— <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUI.IDER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />I I YES FI NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />---- <br />PLUMBING <br />_ <br />TYPE OF CONST ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />IICCUP.xtr <br />cxouP <br />xO GE BNIII MGUNITS <br />SIZE OF BLDG, <br />NO, OF STORIES <br />BASEMENT <br />I YES I I NO <br />MECHANICAL <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS RED <br />1_1 YES 1 1 NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />I <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />