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APPLICATION FOR CONSTRUCT.JN PERMIT <br />r+. EKP'C'PKR <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL <br />—�- � MAIL ADDRESS <br />CITY pi <br />SToc�.,� Z933 �oc'tCr�r.�E <br />f^ MA CJL ifN CITY <br />!ACADDRESS <br />OR DESIGNER —A11 ADDRESS CITY <br />A-. 'At <br />MAII <br />Wn <br />Wrt <br />PLDMBMG CONTRACTOR <br />MAIL ADURESS W <br />CUSS OF WORK .. <br />❑ NEW G ADDITION ALTERATION _ REPAIR <br />TENANT WPROVEMENT OR INTERIOR REMODEL ONLY <br />MgPOSED USE OF BUt1MG A <br />6,ewfol / riAi <br />LEGAL DESCRIPTION OF PROPERTY ISNOWN BELOW OR <br />LOT. q f /O BLOCK l% _OF_ <br />PLUMBING <br />P ' <br />y7 5't I- /�L <br />;F <br />Zip PHONE <br />ZIP PHONE <br />Zip PHONE LICENSE <br />1'HV L <br />1'NVrvt <br />)UTION .. WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVt KIZAU nnv -^•--- -- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK NOT THE LGRANTING OF AL BE D ERMIWITH TyDOES NOT PRHETHER IESUME FIED HETEIN OR <br />GIVE <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 />CONTRACTPRS LAW 18.27 RCW AND 296.200 WAC. <br />SIG URE OF ONTRACTOR OR AUTHORIZED AGENT DATE <br />1/71- A- i N <br />OACT ADDRESS <br />PLIC OITY 9USINESS LICENSE NO ANO BUSINESS NAME <br />-- <br />M H ICAL <br />FEE <br />PLUMBING <br />NO TYPE OF EQUIPMENT <br />NO, TYPE OR TEM <br />FILLKTU <br />FEE <br />A r AIHNDLG UNITS-H.P. _ <br />ET I'OILE11 <br />WATER CLOSET �� <br />FORCED AIR SYSTEMS-B T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />- <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK P DISP <br />RANGE HOOD <br />-- <br />DISHWASHER <br />WATER HEATER <br />LAUNDRYTRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />- <br />BACKFLOW FIRE!'EN TIERS <br />-�-- <br />EXHAUST FAN <br />ROOF DRAINS- :LEADERS <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUB TOTAL <br />S <br />-"— PERMIT <br />$ — <br />PERMIT <br />S <br />TOTAL FEE <br />$ <br />FEE <br />RECEIPT NO. <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FRONT SETBACK <br />FEE <br />FEES VALUATION <br />USE ZONE LOT AREA <br />VACANT SITE <br />❑ YES 1, NO <br />BUILDING <br />TYPE OF CONST. ALIOWABLE TYPE Dt L ONST. FLiI t <br />I=, KT AO VOw4UA, U+"S <br />GAWF <br />PLUMBING <br />---T� <br />SIZE OF BLDG. NO OF STORIES <br />BASEMENT <br />-1 NO <br />MECHANICAL <br />FIRESPRNKLERSREOD <br />7 YES <br />HEIGHT LIMITATION <br />OTHER <br />--- <br />OCCUPANCY LOAD <br />[j YES Cl NO <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRINKLFAS <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY PLANS APPROVED BY CITY DF EVERETT <br />SALES <br />PUBLIC WORKS <br />�— <br />LOCAL <br />TAX CODE IS 3105 <br />TOTAL <br />