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APPLICATItA FOR CONSTRUCT vbN PERMIT <br />tv bwpwn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />-:O BE COMPLETED IN INK —PLEASE PRINT <br />?{ DEMOLITION : I COMBINATION <br />MAIL ADDRESS <br />YPt vC <br />1 . AA` �G ci a Z933 <br />TENANT MALL ADDRESS <br />ARCHITECT OR DESIGNER MAIL <br />BUILDING MECHANICAL <br />CITY 21P PHONE <br />/S Zoi <br />CITY ZIP PHONE <br />CITY <br />PHONE <br />PLUMBING a SIGN <br />335-J3z; <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />IfVbf%A14� <br />MECHANIC NI CWRACIOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS Cl 1A IRK IV <br />Mcw "Anmm�N AITPRATtnN REPAIR DEMGLITION WOODSTOVE/FRPL INSERT ❑BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERK)R REMODEL ONLY <br />CONTRACT PRICE OF WORK: <br />CONT.,CT PERSON AND PHONE N0. <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING / <br />�E�oL J T 5 <br />_ 2— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />ILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />MOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 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 />APPLIWION IS MADE AND I COMPLY WITH THE STATE <br />CONjAAC ORS LAW 18.27 R D 296,200 WAC. <br />SIGIG TURE CONTRACTOR OR AUTO AGENT DATE <br />' <br />LEGS. DESCRIPTION OF PROPERTY BELOW OR A Fou coPIESI <br />/ <br />LOTS- 99/O BLocK of <br />/So's WAPL- Oslo-68s=r�rfj-oso <br />PROJECT ADDRESS <br />- <br />APPLI T TY USINESS LICENSE NO AND BASSN�"E <br />PLUMBING <br />MjtCHAOICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />'JENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WAShE , <br />WOOD STOVE <br />URINAL. <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />i- <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />BER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AFEA <br />VACANT SITE <br />❑ YES ❑ NO <br />VALUATION <br />I-F.E <br />T <br />' <br />TYPF OF COAST ALLOWABLE <br />TYPE Of CONST. ACTUAL <br />oLLUMNO <br />GNwP <br />NO N DWI(LING UN'TS- <br />�— <br />SIZE OF BLDG. <br />NO OF STORIES <br />SASEM Vi ED YES IJ NO <br />:"M:ECHANICAL <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD <br />❑ YES ❑ NO <br />REASON FOR SPRINKLERS <br />HE.GHT LIMITATION <br />SURCHARCE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWOPKS <br />TOTAL <br />_ <br />