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APPLICATIOd FOR CONSTRUCT ON PERMIT everett <br />PIP Evwgrwn TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY CF ��•�—TO/ •�( <br />everett IrgTSYSTEM: ❑GAS ®ELECTRIC ❑ <br />BUILDING DEPARTMENT LL__ —— <br />259-8810 <br />DEMOLITION Y, COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER / MAIL ADDRESS C. ZIP PHONE <br />TENANT MAIL ADORES$ CITY ZIP PHONE <br />ARCHITECT OR DESIGNEr MAIL ADDRESS <br />CITY <br />;.IP <br />PHONE <br />gz k �L f LsL A l�A_) jco 31 3jrAe <br />1wNIja—It <br />`; Cm, <br />7 76 <br />GE NERAL CCNTRACTOf, MAIL ADDRESS <br />lbTY <br />ZIP <br />PHONE <br />LICENSER <br />ak;, <br />�i <br />��l <br />/1U7/�kl;'123GA <br />MECHANICAL CONTRACTGR MAIL ADDRIESS <br />CITY _ <br />71P— <br />PHONE <br />LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />2 <br />L <br />R <br />CLASS OF WORK <br />NEW ❑ ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FHPL INSERT Ll BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHON[ N0. <br />' <br />DESCRIBE 1VORK ATiD SW ARE FOOTAGE INVOLVED <br />allAwX <br />PROPOSED USE OF BUILDING <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 OH CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR' OCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF 'ONSTRUCTION. 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. p <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE I2-I-T- 11 <br />LEIAL OESCFIPTIONO ROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />'OT___ BLOCK of <br />n �r <br />A Z"I <br />JECT I.DD SS <br />PPCIECT <br />APPLICANTb CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITE;.. <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH PASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />;LCTHES DRYERS <br />_ <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWAL3HER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />_ <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />F IREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />T <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FA_:' <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />- <br />T <br />I <br />T <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />T— <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />-RONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO <br />vW <br />.moo ,:5 <br />a3ov. [� <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />OdO �j <br />ao <br />TYPE OF CONTS ALLOWABLE <br />711E OF CONST.ACTUAL <br />.ccuPevP <br />xU aOWRUNS UNITS <br />I F. <br />l._ <br />cnocv <br />PLUMBING <br />SIZE OF BLDG <br />NL. OF STORIES <br />BASEMENT- <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OGC ANC'(1LOAD FIRTESSPPRRNKLERS REO'D HEIGHT LIMITATION <br />5 <br />1 h <br />OTHER <br />REASON FOR SPRINKLERS—/' <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS PPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />1 <br />TAX CODE IS 3105 <br />