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the Ewrgr"n <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICN"ON FOR CONSTRUUTION <br />PERMIT <br />i <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />`I�•Iy1 MAIL ADDRESS CITY <br />ZIP -HONE <br />ARCHlt C11T,� 1�O♦LR DE5IGNER <br />Y A'•ANR CITY <br />21P PHONE LIGENSEA <br />GENERAL C1O11NTRACTOR MAIL ADDRESS <br />CWIY4 <br />MECHANICALCONIRAOIORA _ MAIL ADDRESS CIIY -21P _ PaOf=E ,-" l LICENSE <br />1 II <br />oz- <br />rI _ Fl .. fl wnnncTYYVWFRPI wSFnT ❑ BUILDING RELOCATION <br />❑ NEW L-I ADDITION FA ALTERATION LJ Ii EPAM I --I <br />CONIACI PERSONA NO PIIONE NO. <br />DEL <br />TENANT IMPROVEMENT OR INIERIJ//R MONLY <br />-- <br />CONTRACT PRICE OF WORFOOTAGE <br />-- <br />DESCRIBE WORK AND SOV R FOOTAGEI VOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />PROPOSE u5E of BUILDING <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />"G /��a� <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />LEGAL DESOnmuoN Of PR ERTY IsnowN BELOW Dn Aneal roun <br />CDrIESI <br />WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OFAPERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STAT E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />LOI RLDCK_ or <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAD. <br />— <br />SIGNATURE OF CONI"APOR OR AUIHOn12EO AGENT DATE <br />_----_� <br />APPLICCII V OVSINES�CENSE NO. AND BUSINESS NAME <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />A/C—A/HNOLG UNITS— H.P. <br />WATER CLOSET (TOILET) <br />_ <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATHTUB ____ <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />_ <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK d DISR _ <br />VENTILATION FAN <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY _ <br />_ __ <br />— <br />WOOD STOVE <br />— <br />CLOTHESWASHER _ <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />HEAT PUMP <br />FLOOR DRAIN <br />_ <br />_ <br />GAS PIPING <br />— <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-- RAINLEADERS <br />_ <br />E1AUST FAN <br />SINK (SERVICE— BAR, ETC.)yllU <br />'�XH <br />SUBTOTAL <br />E <br />SUBTOTAL E <br />PERMIT <br />P <br />E <br />PERMIT E <br />_ <br />TOTAL FEE <br />E <br />TOTAL FEE E <br />FEE RECEIPTNO. <br />FRONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMB ER <br />USE ZONE <br />-LOT <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TYPE OF CONS!. <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF STORIES <br />BSMT. <br />Ely <br />OCG LOAD <br />MECHANICAL <br />OTHER <br />ON <br />NElGlli LIMITAT1011 <br />STATE BUILDING SURCHARGE <br />I RE SPRINKLERS PEOGIRED ❑ YES IT NO <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICATION PCC. BY PLANS APPR. DY <br />TOTAL <br />