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APPLICATILA FOR CONSTRUC7.ON PERMIT everett <br />the E•+ergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: � GAS ❑ELECTRIC U _ <br />BUILDING DEPARTMEN r — <br />259-8810 <br />!DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />�OWN R MAIL ADDRESS CITY ZIP PHONE <br />'4 P��.u�ti��'�lJ, fir. <br />TEfIA� MAIL ADDRESS CITY 21P PHONE <br />Li=�IOrA✓G, EOGE �'lLrN»^LBsI_[GS a7ao.�9� ,Ifreaf `,moo/ hoc -asy aoia <br />ARCHITECT OR DE IGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL t,ONT AC MAIL ADDRESS CITY ZIP PHONE LICENSE: <br />MECHANICALFON gACTOfl MAILADDRESS CITY <br />ZIP PHONE LICEN.=EN <br />_ by S�D�re{� <br />PLUMBING RACT➢R A1ML ADDRESS CITY ZIP PHONE LICENSE N <br />CIASS OF WORK <br />NEW ! ADDITION ,)(ALTERATION ! REPAIR ❑ DEMOLITION WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />Vi <br />X <br />00 7 BOG <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO IV 0 (t6 rn T <br />DESCRIBE WORK AND SOUARE FOOTAG NVDLVED <br />ob 4 <br />PROPOSED USE OF BUILDING <br />C uJp �gf f C Q/fc ✓GM L/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO. ,SIONS 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 LONSTRUCTION. 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 />�SSIIGNAArTURE/OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />/LL/a .' -oe, /1 <br />LEGAL DEC IPTION OF PROPERTY (SHOWN BELOW OR'ATTACH FOUR COPIES) <br />wn C <br />LOT BLOCK d�yl�— of �.t v <br />acre T+aAk a&lwe <br />�SC C/R,J ��, .�rJ <br />PROIE.CTADDRESS <br />// � % a. <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <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.R <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M A= <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />T_ <br />T <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />_ <br />REAR SETBACK <br />S'T7 n1Gr- <br />SIDE SETBACK <br />` <br />PLAN CHECK NUMBER <br />�� /0 $7 <br />FEE '� L� <br />RECEIPT NO. <br />So <br />DSez E <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />'/ SOO <br />i'oo <br />TYPE OF CONTS. ALLOWABLE <br />Iv -N <br />TYPE OF CONST ACTUAL <br />v-'/ <br />xauvANC <br />GRppP <br />a <br />NO(VOWFLLINGUNITS <br />PLUMBING <br />'� <br />SIZE OF BLDG, <br />/y yoo sq. rT. <br />NO. OF STORIES <br />z <br />BA �ME/ IT <br />ND <br />MECHANICAL <br />T <br />, <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY /LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />7 L+ <br />REASON FOR SPRINKLERS <br />OTHER <br />>-- <br />STATE BLI'I DING SURCHARGE <br />!/ SO <br />INTAKE BY <br />PLIJNSAPPROVED BY CITYOFEVERETT <br />iLl y�l LOCAL SALES <br />��IJ NCR TAX CODE IS 3105 <br />PUBLIC WORKE <br />TOTAL <br />