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APPLICATIOkv FOR CONSTRUCTIvN PERMIT <br />everett <br />ItI <br />l F"relgmn u <br />Gil <br />e <br />CIl V OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 <br />I I DEMOLITION I I COMBINATION I BUILDING I I MECHANICAL i 1 PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP PHONE <br />y _ <br />APGIIITECT OR DESIGNER MAR ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAR ADDRESS <br />CITY ZIP <br />Y PHONE LICENSE F <br />2 i 17 neTQIViI 1C' 7/ rzr.iic <br />I <br />WA <br />f CITY ZIP ru�nc ...-..--- <br />MECIIANICALCONTRALTOR MPIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />^ITY ZIP PHONE IICENSEA <br />CLASS OF WORK <br />� REPAIR I I DEMOLITION I I WUODSTOVElFRPL INSERT L I BUILDING RELOCATION <br />l i NEW I l ADDITION I I ALTERATION <br />TENANT IMPROVEMENT OR INTERIOR REMO L NLYCle) -. <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK: J <br />DESCRIBE WORK AND SOUAFE FOOTAGE INVOLVED <br />c 171%t.�ET <br />— <br />HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />I <br />AN'D KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />f1✓♦ <br />APPLICATION <br />OF'.AWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY ISMOWN BELOW OR ATTACIIFOUR COPIES) <br />PROVISIONS <br />WORK WILL BE (:OMPI. ETED WITH WHETHER SPECIFIED HEREIN OR <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />NOT. <br />TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />AUTHORITY <br />OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />OTHER STATE <br />OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />PERFORMANCE <br />OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />OWNER <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUNIORIZED AGENT DATE <br />PROJECT <br />ADDRESS <br />APPIICANTS CITY BUSINESS I ICENS OAND BUSINESS AME <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />AIG—AIHNDLG UNITS—H.P. <br />WATER CLOSET (TOILET) <br />' <br />FO RCED AIR SYSTEMS—B.T.U. M E.A. ' <br />BATHTUB <br />UNIT NEATENS—B.T.U. M <br />' <br />LAVATORY (WASH BASIN) <br />—~— <br />CLOTHES DRYERS <br />- <br />SHOWER <br />_ <br />VENTILATION FAN <br />' <br />KITCHEN SINK 8 DISP <br />�— <br />RANGE HOOD <br />DISHWASHER <br />LAUNDRY TRAY <br />--- ; <br />WATER HEATER <br />WOOD STOVE <br />— <br />CLOTHES WASHER --- <br />__ <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT _ <br />�;—_- <br />DRINKING FOUNTAIN <br />I <br />—~ <br />-- <br />—""--- <br />HEAT PUMP <br />FLOOR DRAIN <br />1 <br />GAS PIPING <br />' <br />-�-- <br />BACKFLOW PREVENTERS <br />_- <br />ROOF DRAINS--RAINLEADERS <br />— <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />1 <br />1 <br />UBTOTAL <br />$ <br />' <br />SUBTOTAL $ <br />$ <br />fP:ERMIT$PERMIT <br />TOTAL FEE $ <br />AL FEE <br />$L <br />' <br />NO <br />F PONT SE TRACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER FEE <br />RLCLIPT <br />USE 20NE <br />LOT AREA <br />VACANT SITE <br />I I NO <br />FEES VALUATION <br />FEE <br />�f <br />YES <br />BUILDING <br />-- — <br />PLUMBING <br />—1f <br />- <br />TYPE OfCOAST .ALIOINABIE <br />TYPE Of CONST. ACTUAL <br />oauPAxC <br />GRWP <br />xo aPMUlNc uxn6 <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />I- I YES I I NO <br />OTHER <br />_— <br />OCGUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />I- I YES I I NO <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />APPLICATION ACC. BY <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />