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APPLICATItrN FOR CONSTRUC7 �ON PERMIT <br />everett <br />��E��,�� e <br />CI7Y OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOLITION �COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAILqD�RESS CITY 21P PHONE <br />na��d C�erc� Lnn,ovc� "���/��gr�;K ��r�ct� aSaol aSif-`��as <br />TENRNT MAILADDRE55 C�Tv ZiP PHONE <br />$Gv� e <br />ARCMITEGT OR DESIGNER MRII ROpPE55 GTY ZIP PNUNE <br />GENERAL <br />MECHANiGRL <br />PIUMBING <br />MAIL AODRESS <br />MRIL ApDRE55 <br />MAIL ADDPE55 <br />Glry Gn <br />GTY Zli <br />CITV 211 <br />PHONE <br />u��nx • <br />u�enae. <br />CLASS OF WORN <br />I NEW �. � ADDITION � ALTERATION .� REPAIR . DEMOLITION WOODSTOV6FRPL INSERT �, � BUILDING RELOCATION <br />TENANTIMPROVEMENTORINTEPIORREMODELONLY ' CONTAGTPEfi50NANOPHONENO. <br />CONTRAGTPRIGEOFWORK: � ���� <br />DESGRIBEWORKRN�SOUAREFOOiAGEINVOLV[D SEO��9�j <br />�¢rl �„ F! Q.�.� h�l h io���„- �Ala�)��� beci�oan/ <br />BUILDING <br />� V: n n S f) C� c. '�' <br />LOT � � �� 1 BLOCK ��"I 1 OF <br />PRQIECT ADOBE/5'5� <br />� -�sC � <br />PLUMBING <br />NO. TYPE OF FI%TURE OR <br />WATE7 CLOSET (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENTERS <br />FRONTSETBACK <br />USE20NE <br />PERMIT <br />TOTALF <br />RE.1R SETBNCK <br />LOT AREA <br />iYP[ Of LONSi..4lOWABLE I iVPE OF CONSi. AC1UAl <br />SIZE OF BIDG. <br />OCCUPANCVLORO <br />REASON FOR SPP!NNLERS <br />qPPLICATIONACC B� <br />NOAP STOnIE$ <br />FiRE SPRNKLERS RE00 <br />YES NO <br />PLONSAPPR/Oy/� OBV <br />/�/i{.� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFiRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHC?HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF /� PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOL/tT[ OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAI. LAW FEGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br />APPLICATION IS MADE AND I COMPLV WI?H THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SiuNRTURE OF CONTRACiOF OR AUiHORiZEO RGENT �AiE <br />X i_`i���..,�� �l c� 1 °�o <br />APPLIC/NT�BUSINESSIi [NSENOANOBUSMESSNAME <br />TYPEOFEOUIPMENT FEE _ <br />A/C-NHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATEFiS-B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />—=�- <br />RANGEHOOD <br />WATER HEATER ' <br />WOODSTOVE � <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />�- <br />HEAT PUMP ' <br />GAS PIPING <br />$ SUBTOTAL� <br />� PERMIT 5 <br />� ' I I TOTAL FEE 5 <br />SIDESET9AGN PLANCNEGHNOMBEF FEE I AEGEIPTNO <br />VAL'ANT SITE <br />YES NU <br />p��;;rayc+ rva o�ow¢u�•�c <br />G9pVF <br />BASEMENT <br />YES NO <br />HEIGNT LIMITATION <br />CITY DF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />FEES VALUATION FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEF <br />STATE BWLDING SURCHARGE <br />STATEENERGVSURCHAFGB <br />PUBLIC WORNS <br />TOTAL , <br />