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APPLICATION FOR CONSTRUCtION PERMIT <br />everett I <br />dw ElwrprlKlR <br />CITY OF e <br />everett <br />BUILDING DEPARTMENT 259-0010 7 BE COMPLETED IN INK —PLEASE PRINT <br />DEMOLITION X COMBINATIOA I I BUILDING I I MECHANICAL 1 1 PLUMBING I I SIGN <br />CANEn MAIL ADDRESS city ZIP PHONE <br />IR�La_fI/)5.5INCI I`lll 51 E6'172)`IT r1,11.1 1-S7-C`i`i}' <br />TkNANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT On DESIGNI: R MAR ADDRESS CITY ZIP PHONE <br />C H1/1 <br />GENERAL CONTRACTOR MAIL ADDRESS city ZIP PHONE LICENSE <br />aGNsr, 1.131- M101Lli0 111,411 11Ff"•1 1,1014,3c 1/L3c,-Y <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP P14ONE LICENSE <br />PLUMRF If, CONHIAC1011 MAR ADDRESS CITY <br />CLASS Or WORK <br />1 1 NEW I I ADDITION <br />PIKNNr <br />I I ALTERATION 18 REPAIR I I DEMOLITION I I WGODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENt 09INtER10n nEMOOEI. ONLY <br />COIOACI rE1150N AND PHONE NO <br />CONTRACT PRICE OF WORK: tI bece - <br />-- <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />__ <br />COI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSEDUSE OFBUILDING <br />51d j ,.-t p <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL OF SCRIPTION OF PROPERTY IS140M BELOW OR ATTACH roue COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LD111 nrll 1 L BLOCK 39 2 OF 3 i M7E NG' h 11nn <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 WAC. <br />SIGNAIUREOFCONINACTOn ORAU111ORIZED AGENT DATE <br />PROXCI ADDRESS <br />APPI'CAN ISCITY ROSINESSUCENSFNOAND BUSINESS NAME <br />IT ITT - <br />h ,I I <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—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />' <br />UNIT HEATERS—B.T.U. M <br />_ <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISPPfb b I` P 1 <br />i <br />VENTILATION FAN <br />DISHWASHER <br />---_� <br />RANGE HOOD _ <br />LAUNDRY TRAY <br />_�_ <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE_ <br />URINAL <br />_ <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />_ _i <br />HEAT PLIMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />—?— <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />' <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />— <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE 2011' <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEES_ <br />BUILDING <br />- <br />_ -- <br />I I YES I I NO <br />7YP[0I CONST ALIOWARIT <br />TYI4 DI CONS) ACIUq <br />ntamulF.r <br />room <br />MIpPMII'Nf uMnS <br />PLUMBING <br />SIZE OF BLDG <br />NO Or STORIES <br />BASEMENT <br />MECHANICAL <br />I I YES I I NO <br />— <br />OTHER <br />"— <br />OCCUPANCY LOAD FIRE SPRNKLERS REDD <br />IIEIGIII LIMITAIK)N <br />STATE BUILDING SURCHARGE <br />r <br />1] YES I I NO <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />APPLICATION Acc. er <br />rknnsnrrnoveoer <br />CITY OF EVERETT <br />PLOT C WCRKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />