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s rV <br />APPLICAT16A FOR CONSTRUCTION PERMIT <br />{ FTO BE COMPLETED IN INK -PLEASE PRINT <br />I a <br />Is I <br />Elm <br />Rdo <br />all <br />MH <br />op <br />a <br />O <br />Me Ewrgreen <br />CITY OF <br />everett <br />HEATING SYSTEM: ❑GAS <br />❑ELECTRIC ❑ — - - - <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />XBUILDING <br />MECHANICAL PLUMBING <br />SIGN <br />O�WNER / if —Q MAI AD��[F/IESS <br />CITY I, <br />✓ <br />ZIpP.gol PHONE —� �6 <br />6�- <br />''- /�/LIDLn <br />�70%7L�Z�iY <br />CJ F/'� <br />.7 <br />TENANT If <br />MAIL ADDRESS <br />CITY21P <br />PHI <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />21P PHONE <br />No n/& <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />/liox <br />CITY <br />aoY�Cuvc°PYi <br />21P PNONE LICENSE/ <br />9�ao3 3a7-yaaa- DAn)fl-GC <br />z_83 A3 <br />Phar�P <br />11-2 <br />�c'LLu,cP <br />MECHANICAL TRACTO <br />p" <br />MAIL ADDRESS <br />Cltt <br />ZIP PHONE LICENSER <br />NG k e <br />PI UMBINC• CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE <br />NoNe <br />CLASS Lw WORK <br />V O..A.O I EgUnl MEIN <br />WOODSTOVETFRPL INSERT ❑ BUILDING RELOCATION <br />/f /J OC <br />\ <br />CONTACT PERSON AND PHONE NO -T <br />1•elo�L�l���-�•� y� <br />CQVTRACT PRICE OF WORK /G eG <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED // CJF/L <br />;e ram' 'eoof d'v / C'�i/�.V s <br />PROPOSED USE Or BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />P P <br />PROVISIONS OF LAWS :ND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEG LUE SCRIPDON OF PROPERtt ISNOWNBELOW ORATTAGN FOURCOPIESI <br />LOT BLOCK OF <br />NOT. 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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAG. <br />SyIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DA <br />C / <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS L NSE ANDSUSWESS NA E <br />7 L.iB G .d u f _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A)C-A/HNDLG UNI TS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATO.'1Y (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />—T <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWAS4ER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACES CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACEINSERT <br />T <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />------------------- <br />SUBTOTAL $ <br />' <br />SUBTOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAI. FEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />__REAM _SVTBACK <br />SIDESETBACK <br />PLANCHFCKNUMBER <br />ICI <br />RECEIPT NO <br />USEZONE <br />LCT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />-- <br />I <br />TYPE OF CENTS. ALLOWABIE <br />TYPE OF CONST. ACTUAL <br />pAIIMNCr <br />IKEF LLgGUNITS <br />cnav <br />PLUMBING <br />i <br />-- T— <br />_ <br />SIZE OFBLOG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REDO HEIGHTLIMITATION <br />I <br />OTHER <br />1 <br />REASON FOR SPRINKLERS <br />SURCHARGE <br />STATE BUILDING <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBI IC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/ S- <br />A <br />