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Nish <br />9y <br />D <br />ayvJ <br />rm <br />H a 2a <br />Hyc z 0 <br />y t1 <br />AD ­tlt <br />y y HH <br />C OA <br />y0 <br />� cg <br />G� • C] <br />r zyH <br />8 H <br />C) C7 y <br />��LrE1 <br />z H3 co <br />H3 ON <br />APPLICATION FOR CONSTRUC'v iON PERMIT <br />rcoFcll <br />crtYOF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />><25D9� <br />E810 MOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />CITY TIP PHONE <br />TENANT Y, MAIL AD� �O~ �VCITV Pl IC. EIP �I��HON��� �YA 'Y Imo% <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL "A MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSEI <br />MECHANICAL CON ACTOR MAIL ADDRESS <br />GITV <br />ZiP <br />PHONE <br />UCENSEF <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LM1icnac• <br />CLASS OF WORK <br />oconln AAnI ITIOIJ <br />WOODSTOVE/FRPL INSERT <br />-, BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL�O/tj�Y <br />CONTRACT PRICE OF WORK: <br />CONTACT PERSON AND PHONE NO 2� <br />TAGE IN <br />�✓• <br />CRIBE WORK ANDSWAREF L <br />�j"_ <br />/'j y'j,,, <br />J7 <br />�y _i/�✓ <br />R PDSEDu oF BUTNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />• <br />eI <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 DEscmerro F PROPERTY SHOWN BE o OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE CANCEL THE PROVISIONS OF ANY <br />�d h <br />I '�► <br />_ <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 CONTRACTOR OR AU IZED AGENT DATE q <br />X^Q <br />PROJECT ADDRESS <br />— <br />APP TSCITYBUSINE SUCEN iANp USINESB NAME <br />PLUMOINO <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYP 0 EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />AIC—NHNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERIS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />i <br />1 <br />' <br />SUBTOTAL <br />$ <br />SUBTOTAL b <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />❑ YES ❑ NO <br />TYPE a CONSTOW . ALLABLE <br />TYPE OF CONST. ACTUAL <br />aNAtKr <br />Lp° <br />KO aPMUMGIMns <br />- <br />PLUMBING <br />SIZE OF BLGG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />YES i_ i NO <br />OTHER <br />OCCUPANCYLOAD FIRE SPRINKLERS REO'D <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />❑ YES NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />