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H O TA <br />APPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />I•chThll <br />I'Ir L�aF9.^nF <br />GIiV OF <br />everett <br />e <br />BUILDING DEPARTMENT TO BE COMPLETED <br />IN INK —PLEASE PRINT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING <br />MECHANICAL <br />PLUTABING <br />SIGN <br />'OME/�,," <br />[/f I 12 ?. <br />CITY ZIP PIIO',L <br />D Ew+9 fltq <br />d _ oy t. <br />-Ad, <br />—Ad, MAIL Es- <br />TENANT <br />Zh✓c <br />ip PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSER <br />PLUMBING CONTRACTOR MAR ADDRESS <br />CITY ZIP PHONE <br />LICENSE <br />CUSS OF WDRK nmAnl ITInM wnnnSTnVF)FRPL INSERT L BUILDING RELOCATION <br />^` ` ^ v' <br />TENANT IMPROVEMENT OR INTERIOR RE „ �L, <br />a•/��(. •tI_ <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF MORN: <br />DESCRIBE WORN AND SOVARE FOOTAGE I OLVED <br />12�M��uTua� r_A,r <br />�t°TU )ST)^ <br />READ AND EXAMINED THIS <br />PROPO�ED USE OF BUILOUIGUSE OF BUILDING 4Y 1p <br />^ n.�f <br />VwV-1AI A-Lo -'L PLti <br />1 HEREBY CERTIFY THAT I HAVE <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 />LEGAL DESLRIPTNNIOF PROPERTY I5NOWU BELOW OR ATTACH FWR COPIESI <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LDT <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 CONTRACTORROO/RAAU/UTT�/pJ {1IZED AGENT DATE <br />X <br />APPLICANTS CITY BUSINESS LICENSE N ID BUSINESS NAME <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF UIPMENT FEE <br />WATER CLOSET (TOILET) <br />AC—A,HNDLG UNITS—H.P <br />�G <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />51 <br />VENTILATION FAN <br />i <br />I <br />DISHWASHER <br />RANGE I'OOD <br />--i <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINL:ADERS <br />-EEXXH-A—UST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />SUB TOTAL <br />$ <br />_�UPERMIT <br />$ <br />-.--��- <br />ol.CIT <br />TOTAL FEE <br />S <br />I FONTSETBACK <br />AEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NDIIPE'CEIPT <br />VPERMITS <br />NOUSE <br />ZONE <br />LOT AREA <br />VACANT SITE � <br />YES '^0 <br />FEESFEE`1 <br />BUILDING1 <br />J ' —TYPE <br />OF CONST.ALLTWABLE <br />TYPE OF CONST ACTUALACUWYcr <br />un (N OATLLIM4NNIm <br />PLUMBING <br />SIZE OF BLDG. <br />NO, OF ST S <br />BASEMENT <br />MECHANICAL <br />f YES NO <br />OTHER <br />'c`\ <br />OCCUPANCY LOAD FIRE SPRNKLERS REEDDTI <br />HEIGTLIMITATION <br />I I YES / rv0 <br />STATE BUILDING SURCHARGE <br />i50 <br />STATE ENERGY SURCHARGE <br />RLASM FOR SPRINKLERS <br />APPLICATION ACC, BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUOLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />