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APPLICATIC`1 FOR CONSTRUCT ON PERMIT Iep <br />IMEmVIRF, TO BE COMPLETED IN INK —PLEASE PRINT <br />CITYOF <br />everett <br />BUILDING DEPARTMENT <br />259•SB10 <br />,I DEMOLITION Li <br />ER MM <br />1P Vil I'1 ' ( n I I I <br />HEATING SYSTEM: MOAS ❑ ELECTRIC ❑ j <br />TENANT <br />MAA AWAE66 <br />CITY <br />ZIP <br />PHONE - <br />ARCHRFCTOAD[BIGMER <br />MAAODAESS <br />CRY <br />ZV <br />PNOME <br />GENERAL CDNTRACTOR <br />MIL ADDRESS <br />CITY <br />ZIP <br />PHONE UICEMSE6 <br />CLA990FNORK <br />VNEW ❑ ADDITION ❑ ALTERATION C REPAIR DEMOLITION WOO)STOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />CONTpAGi PRKE OFWOUt �b I/I'jO T) Y <br />CONTACTPERSONANDPHONENO <br />DESCRIBE YrGRR ANp6WAR fOpTAGE NVGLVEO <br />PROPosEO USE OF oNG <br />C 7 I LI D. 11, 'n f ,I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SANE 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTNOAOD AGENT PATE <br />is n (I1j11 <br />\ ,/ nA.L� �k !� n (.P.S �- <br />LEGALDESPAIPTKNOF PRGPEPTYIBNf�ON BELOW OR ATTACH FOIACOPIF51 <br />LOT BLocK a _ <br />PROJECT ADM[59 <br />/�/� /L_ 7Ah !U�/� <br />APRKANT5CITYBUSNESSLKENSENOA BUSINESSNAME <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 —A HNDLG UNITS—H.P <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—B.T,U. NI <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL <br />$1 <br />SUB TOTAL f <br />�. <br />PERMIT <br />$ <br />PERMIT sl <br />J,-, — <br />TOTALFEE <br />f <br />I <br />TOTAL FEE f <br />C_"E= <br />I FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REM SETBACK <br />I`. <br />BOB SETBACK <br />PLAN CNECR NUMBER <br />FEE <br />RECEIPTNO <br />USE ZONE <br />LOT AREA <br />YACMNTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />IYFE or CONTE.FiUDW.VIE <br />TYPE M CCNST ACTUAL <br />EC(IIrFLtr W ppR I,4 UUMII <br />Erol <br />SIZE OF SLOG <br />NO. a 111 <br />EASEMENT <br />MECHANICAL <br />A�•^�� <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNK`I.E.^.!^EGG HEKHTLMITATKN <br />REASGNFGRBPRNKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />INTME BY KIIS APAROED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE 13 3105 <br />PUBLIC WORKS <br />TOTAL <br />