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0 <br />APPLICATIOC�FOR CONSTRUCT�'N PERMIT <br />tne Eve�g�een TO BE COMPLETED IN INK—PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMEN7 <br />259-8810 <br />HEATING SYSTEM: Q GAS ❑ ELECTRIC ❑ <br />everett <br />e <br />❑ DEMOLITION i 1 COMBINATION C! BUILDING i�NIECHANICAL PLUMBING 7 SIGN <br />` OWNER MqI�A�OflE55 CITY ZIP// PNONE <br />�.vnn hierK� � �3(�� S�h�p� (�) Fvar��� qY���/ 25°I--7�257 <br />TE �NT MAILADDRESS CITY 21P PHONE <br />�me �� ("l���r��r <br />ARCMITELTORDESIGNER MAILADDRE55 CIIY ZIP PHONE <br />; __.._... __ ............. ......_..__..___ ... .... �,,..�.� u�cnac. <br />Val, �N I�� n�s 2��ns 1111�,�„ (l ��. F,��,�-H `1X2(�1 �s�-sy9�- V�LLr-.�1� l5 L I <br />MECHA�TqACTOR MAILADDRESS �j GTY ZIP PHONE LICENSER <br />. PLUMBINGCONTRACTOR MAILAODPESS CITY IIP PHONE UCENSE� <br />' CUSSOPWOflN <br />i' C� NEW Ci ADDITION _�TERATION �_' REPAIR i�7 DEMOLITION f_l WOODSTOVFJFflPLINSERT G BUILDINGRELOCATIGN <br />' i /^� /�f CONTACT PFflSON AND PHONE NO. <br />� (i �fl.. <br />� CONTRACT PRICE OF WOFK "� <br />S DESCRIBE WOFN N SOUARE FOOTAGE INYOLVED „ <br />e °E' ) i <br />? PROPOSE�USEOF UILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />3 , j� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />P IEGAL DESCflIPTION OP PROPERN ISHOWN BELOW ORATTACH FOUPCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED 4VITH WHETHER SPECIFIED HEREIN Ofl <br />�oT BLOLK oF 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 1827 RCW AND 296.200 WAC. <br />� SIGNATUREOFCONTRACTORORAUTHORREDAGENT DATE <br />ADDRE55 <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WASI <br />SHOWER <br />KITCHEN SINK & <br />DISHWASHER <br />LAUNDRYTRAY <br />Y✓ <br />ITEM <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FEE <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SEIBACK <br />� IISEZONE IOTAREA <br />- ttPE OF LONA. ALLOWA9lE TYPE OF LONSi ACiUA� <br />OCCUPANCYLOAD <br />REASON FOP. SPRINKLERS <br />INTAKE BY <br />NO.OF STOFIES <br />FIHE SPRNKLERS REO'D <br />PlANSAPPROVEDBY <br />SIOE SETOACK <br />� <br />X t1� � 1' I'? 11'1�0�, '�c� � e �, ���.-� G-a � <br />APPLICANTS CITY BUSINE55 LICENSE NO. AND BOSINESS NNAE I <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/�A/HNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—B.T.0 E.A. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />VACANT SITE FEES <br />BUILDING <br />OO:UGaHtv NO OfDWFlbxG11N115 <br />cnouv pLUM81NG <br />BASEMENT MECHANICAL <br />MEIGHTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEHETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TaTAL <br />I EE <br />PERMIT $ <br />TOTAL FEE $ <br />i � <br />L <br />i <br />