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APPLICAT10�40R CONSTRUCTIQ1 PERMIT eY,ereLt <br />NIB EVBfplBBR <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />+TiJ cln of <br />everett BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br />:7 <br />259-8810 <br />❑ DEMOLI/T`IOyN1 �(/I7II COMBINATION lI 1 BUILDING v�AECHANICAL ❑ PLUMBING ❑ SIGN <br />Oj1 AA �TT 1 YIA/j' ILII PHONE <br />MAIL AD <br />1�y <br />lY� iJI 1 Ali <br />TENAj%J MAIL ADDRESS CITY ZIP PHONE <br />I <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />2605 McDougall <br />CLASS OF WORK <br />❑ NEW [ 1 ADDITION \ - LTERATION I I REPAIR I I DEMOLITION I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORN `_ <br />CONTACT PERSON AND PHONE NO. <br />OESC Els'j(R�N�SW/AREFOOTAGE N(OLVE <br />PROPOSED USE OF BUILDING 'Wn <br />t-P2) <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 />AUTHORIT" 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />`-blo(t�` /'' 1 Aa,,Aud <br />BUSINESS UtENSE NO. "USINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <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 />I <br />A/C--A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATOR" (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />T <br />I <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR, ETC.) <br />' <br />� <br />I <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />26 ' ^ <br />PERMIT <br />$ <br />PERMIT $ <br />/ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />`/— <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONSS. ALLOWABLE <br />TYPE OF CONS, ACTUAL <br />OCCUPANCY <br />NO MOABONG U41T5 <br />GRWP <br />PLUMBING <br />' <br />SRE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICALi <br />y — <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�� I <br />