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APPLIL.ATION FOR CONSThJCTION <br />PERMIT <br />the Fverpreen <br />rvrrcll <br />(.11 Y OF <br />everett <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />259•BB10 <br />OWNER <br />MAIL ApORC55 <br />fllY .'6' <br />VHOIIL <br />=e <br />/ 35_L <br />wt ...F. ni <br />r s__�rwee-Af <br />MAIL ADDRL55 <br />CITY ZIP <br />PHONE <br />TENANT <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS -- - - <br />—CRY ZIP <br />- - - PHOiiE <br />- <br />GENERAL CONTRACTOR <br />MAIL ADDRESS--_ <br />CITY ZIT' <br />14KtNI <br />I f <br />�'%trC (7..•ra q4 <br />iti i�c�_T�it•Gdr/—e�J <br />a.t—LSQ.L-. _.. <br />._�'�'.er lli "-'' <br />JZb'�'t�G5 `!?_2� <br />PHONE LICENSE <br />./1J.t <br />MAILA DRNE <br />ESS <br />(CITY ZIP <br />MECHANICALfONTRACIOR �IJ� <br />PLUMBING CONTRACTOR <br />MAIL AD615UgS <br />CITY ZIP <br />1'IIONE <br />LICENSE IF <br />.LASS OF WORK <br />n ., fl wnnOC1(1V41FRPI INSERT ❑ BUILDING RELOCATION <br />u new u nU.11. rY , ".—...... �• ••_. ..... — __..____ <br />TENANT IMPROVEMENTORINTERIORREMODEL/ONLY <br />u7 <br />_ ___ <br />CONTACt PERSON AND PITONS NO <br />CONTRACT PRICE OF WORK: <br />MPO���� <br />OF BUILDING <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS APPLICATION AND <br />OF AND <br />AND CORRECTFWORK <br />KNOW THE SAME TOORDINANCES <br />ILL BEIONS <br />DOVE KING T COMPLE COMPLETED <br />SGOVED HEREIN OR TYPE OF WORK GRANTING OF PERMIT TEDWITT <br />1V11ETHERSPECIFIEDHEREINOR NOT. TIIEGRANTING OFAPERMIT DOES NOT <br />WHET) HER <br />TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LEGAL DESCRIPTION OF PROPERTY ISHDWN BELOW OR ATTACH FOUR COPIES, <br />-11 <br />PRESUME <br />CONSTRUCTION OR THE PEFF <br />LOT-- BLOCK__ OF 11 k 1 �_f_(--.L.YJ <br />ANY OTHER STATE OR LOCAL LAW REGUI. ATING <br />FORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE OWNER OF <br />_ <br />A•-��- �� ��i'7 �`��= <br />THIS PROPERTY TO PERFORM 111E WORK FOR WHICH APPLICATION IS MADE <br />II - <br />I� <br />AND 1 COMPLY Willi THE STATE CONTRACTORS LAW 18.27 RCW AND <br />2962DD WAG. <br />SIGNAIIIRE OF CONTR�AACCIOOII�nil AUNIORIZED AGENT DATE <br />,` <br />Pt10JECTADDRESS _ <br />01 <br />APR ILA��INC551 ENSF NO ANp BUS�NAME <br />1- J ) <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A, C -- A/HNDLG UNITS - H.R <br />AIR SYSTEMS- BT.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_FORCED <br />UNIT HEATERS_- BTU. M <br />_ <br />_ _ _ <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISP. <br />DISHWASHER <br />LAUNDRY TRAY <br />VENTILATION FAN <br />RANGE HOOD <br />_ <br />WATER HEATER <br />_ <br />__ <br />WOOD STOVE _ <br />CLOTHESWASHER <br />METAL FIREPLACE A CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />— <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE - BAR. ETC) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />_ __ __ PERMIT <br />_ <br />TOTAL FEE S <br />TOTAL FEE $ <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />PLANCHECK NUMBER FEE RECEIPT NO. <br />FEES <br />VALUATION <br />FEE <br />USE ONE <br />LOTAREA <br />VACANTSITE <br />11 YES ❑ NO <br />BUILDING <br />fiPEOFCONST <br />OCCUPANCYOROUP <br />NO OF DWELlINO UNITS <br />--- <br />ALLOWABLE/ACTUAL <br />PLUMBING <br />SIZEOF BLDG <br />NO OF STORIES <br />BSMF <br />OCC LOAD <br />MECHANICAL <br />❑V <br />OTHER <br />❑N <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION ACC BY PLANS APPR BY <br />TOTAL <br />