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APPLICATION FOR CONSTRUCTI PERMIT <br />everett <br />the Everyreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8610 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION I I COMBINATION 1-1 BUILDING �ECHANICAI. I I PLUMBING ❑ SIGN <br />1 TCrHONE <br />R I t AI' 0 A l V• i' CITV C ZIP PHONE %1�{.� L„n 1 `,I..� 1 <br />T?I�y`A AAILADORESS L�iC/J I/ a <br />-40I <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CLASS OF WORK t �, <br />CITY ZIP PIIURn <br />I I EMIR 1 I DEMOLITION I I WOODSTOVEIFRPL INSERT I I BUILDING RELOCATION <br />11 NEW I I ADDITION iLHAIIUN <br />R <br />TENANT IMPROVEMENT OR INTERIOR REMODEL Oy11�Y <br />CONTACT PERSON AND PHONE NO. <br />. <br />CONTRACT PLACE OF WORK: L U <br />DESCRIBE WORK D" RF f.F+"ry vcpn/j �7 ��I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROFOS BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />T <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY ISHOYM BELOW OR ATTACH FOUR COPIES) <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />AUTHORITY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION 0;', THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FO:: WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCLN AND 296.200 WAC. <br />IEOF CC,O1E�NT OR AUT 14DRIZED AGE TIT DATE <br />SIGNAL LIVE OF <br />1FACTOR <br />L', <br />I1 <br />�yX//LLa�\Y��LJ LJIn 1 D <br />_ <br />PROJLCT ADOR[SS �1 t <br />ESS NAME <br />APPI )CAN IS GTY BU51ry11EF.S—B IICENSEN AND BUSINESS NAAIE <br />MECHANICAL ' <br />PLUMBING <br />FEE <br />N0. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />ArC—A/HNDLG UNITS —HP. ' <br />WATER CLOSET (TOILET) <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />BATHTUB <br />UNIT HEATERS—B T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />I <br />CLOTHES DRYERS <br />SHOWER <br />SINK 8 DISP <br />' <br />' <br />VENTILATION FAN <br />KITCHEN <br />DISHWASHER <br />I <br />RANGE HOOD <br />( <br />WATER HEATER <br />LAUNDRY TRAY <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />I <br />__ <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />( <br />GAS PIPING <br />�j-- <br />' <br />I <br />i <br />_ <br />_EXHAUST FAN <br />ROOF DRAINS—RAINLEADERS <br />ETC.) <br />SINK (SERVICE —BAR, <br />1 <br />I <br />I <br />— <br />I <br />� <br />SUBTOTAL $ <br />I <br />' <br />SUBTOTAL <br />$ <br />PERMIT $ <br />PERMIT <br />$ <br />TOTAL FEE $ <br />' <br />TOTAL FEE <br />$ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />FEE T� <br />I I YES I I NO <br />BUILDING <br />_ <br />I <br />TYPE Of CONST. ALLOWABLE <br />TYPE Br CORST. ACT UAL <br />IICNIPANLP <br />LAMP <br />LIBd PNWxGUNnS <br />PLUMBING <br />[VALUATION <br />512E OF BLDG. <br />No. OF STORIES <br />BASEMENT <br />MECHANICAL <br />S I NO <br />OTHER <br />OCCUPANCY LOAD FIRE SPRINKLERS RE00 <br />rlGHTT�LIMITATION' <br />I .I YES I I NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />' <br />I <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />--� <br />LOCAL SALES <br />TAX CODE 13 3105 <br />TOTAL <br />