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the Eve,9,eon <br />CITY OF <br />everett <br />BUILDING DEPARTMENI <br />259-UB10 <br />APPLICI%.'ION FOR CONSTRLy..PTION <br />PERMIT <br />TO BE COMPLETFD IN INK— PLEASE PRINT <br />ml <br />OWNER MAILADDRESS ZIP PHONE <br />I 7p3"r�r321)2- <br />Y� <br />TENANT MAIL ADDRESS E <br />ARCHITECT OR DESIGNER MAIL AGE RESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />©1�1�/EG <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION rJ •LTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVIUFRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMFNT OR INTE <br />CONTRACT PRICE OF WORK <br />IOR 6LNDEL ONLY <br />[7onn <br />CONTACTPERSONANDPHONEHO <br />DESCRIBE WORK Ap WILAPE FOOTAGE INVONEWD � <br />4� .s...A/ <br />0 SEO WEGF MILDING —TJ-- <br />,f�A �t R ♦ �A <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OFWORKWILL BECOMPLETEDWITH <br />WHETHERSPECIFIEDHEREIN OR NOT.THEGRANTING OFAPERMIT DOES NOT <br />PRESUME TO GTVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. TEAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE'NORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STAT: CONTRACTORS LAW 18.17 R�;ND <br />286.2W WAC IO/� ] GGe <br />91DNAFURE NTRAL ENT DATE <br />X ♦ <br />:]'rIICANiCc'.P aNES9 LICENSE NO AND BUS( SS NAME <br />LEGAL RIPTION OF PROPER IBHOWN BELOWORATTACN FOVRCOPIEA <br />n LOT ♦ BLOCK of 1 <br />PROJECT ADDRESS <br />4 0-g Z9.✓2 /� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />j NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —NHNDLG UNITS —H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS— BTU. MEAL <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE— BAR, ETC) <br />SUBTOTAL $ <br />SUBTOTAL II <br />PERMIT A <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE & <br />_ <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCNECKNUMBER <br />FEE <br />RECEIPF NO <br />uFE 2oNE <br />1YPE OF CONST <br />LOTAREA <br />VA NTSITE <br />NYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />ALLOWABLVACTUng-4 <br />..•SSSS���� <br />OCCUPANCY GROUP <br />if-s <br />NO OF DWELLING UNITS <br />/ <br />PLUMBING <br />SIZE OF SLDO. <br />NOCFSSTORIES <br />BSMT. <br />❑ N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REWIRED ❑YES NO <br />HEIONTLIIMUTTAATION <br />N� <br />STATE BUILDING SURCHARGE <br />- <br />C <br />APPLICATION ACC BY PLANSAPP{LBY <br />vI kt /A//^///J� <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />