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APPLICATION FOR CONSTRUCTkoN PERMIT I everetL <br />the Evergreen TO BE COMPLETED IN INK -PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS LJ FLECTRIC Li <br />259.8810 <br />i I DEMOLITION Pf COMBINATION BUILDING I I MECHANICAL !PLUMBING I SIGN <br />OWNER MAIL ADDRESS CITY <br />;e ZIP PHONE <br />EOITN �Qo�NnS 11o'I- _f rew sr, cPzXf.rr `T IftoI <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />C Kro <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />NHL/JnC.J( NET <br />1131 //1L/-/ J A« <br />&JfiECFP <br />''1 61, I <br />LSL -%`rSG NAL/fACM 2IONY <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />/19 �k 13F.AA-•� S t eo � /E�Co/-,.c�.c PU,�.�f n- z��i-Z`l Ko <br />CLASS OF WORK <br />I J NEW I I ADDITION I I ALTERATION Iri REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I. i BUILDING RELOCATION <br />CONTRACT PRICE OF WORK LO OJ _ <br />CONTACT PERSON AND PHONE NO <br />CAA4 Ry 7✓i/Ldj C/.F L -, L-7 `SO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVE T 0111p <br />&1NIPNO o PrR <br />/'(C) <br />ELEz, tr`Rv <br />PROPOSED USEOFBUI DING <br />Qk x(OCr w <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 PROPERTN' TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />I CONTRACTORS LAW 10.27 RCW AND 296.200 WAG. <br />SISNAT➢RE OF CONTRACTOR OR A�UT14OORIIIZZED/A.GENT DATE <br />LEGAL DESCRIPTIqr+ OF PROERTYu1ISI WN BELOW OR ATTACH FOUR COPIES) <br />LOT i� -6 ~yMrBLOCK L4fl-OF <br />S T r/ I CA, oL qj- AAyo <br />- <br />-- —jl <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS L1ENSE NO AND BUSINESS NAMEgy/ <br />U <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />1 <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 />SHOWER <br />CLOTHES DRYERS <br />�— <br />_ <br />( <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF nRAINS-RAINLEADERS <br />) <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />r— <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />-r— <br />PERMIT $ <br />_ <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />2U_� UD <br />TYPE OF CONTS At I OWABI E <br />TYPE OF CONST ACTUAL <br />CC[uPAN<e <br />4fl4UP <br />_ <br />Hn 01 pNR UN4UNiR <br />_ <br />SIZE OF BLDG. <br />TIC. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D ))EIGHT LIMITATION <br />REASON FOR BPRINNI ERS <br />OTHER <br />A—r"—"— <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTALZZA/a <br />