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APPLICAT16:J FOR CONSTRUVF:.. N PERMIT rj*j <br />TO BE COMPLE'! r.. ) IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />M DEMOLITION I I COMBINATION <br />OWNER MAIL ADDRESS <br />ADDRESS <br />11RATING SYSTEM: FJ GAS ❑ ELECTRIC ❑ I <br />BUILDING f IMECHANICAL I_ PLUMBING SIGN <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRES5 <br />CITY <br />ZIP <br />PHONE <br />PHONE LICENSEE <br />GEIIERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />M2ANICALCONTR CTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSEE <br />CLASS OF WORK <br />.r r.coelo 1 I nr=nnnl ITInN I I WOODSTOVE/FRPL INSERT Cl BUILDING RELOCATION <br />LJ NEW I_I AwI I ION I AL5 c <br />- <br />WNTACT PERSON AND PHONE NO <br />UZJ <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />1S X O 11 rG! oe <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIL; <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />FIED HEREIN <br />WORK WI�%? <br />LEG DESCRIPTI01l OF PROPERTY (SHOWN BELOW OR Al IACH FOUR COPIES) <br />LOT BLOCK 90L ub <br />� <br />TO GIIV <br />NOT. THELGRANTIING OF AD ERMIWITH TJDOES NOT PRHETHERIESUME VE <br />, <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />�-Ar-LG, /� I/ <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />lll--- <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 />/ A/ <br />YAIC <br />—ROJECT ADDRESS <br />SCITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MEC ANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—A/HNDLG UNITS—H.P. ' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEAI ERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />_ <br />' <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK & DISF <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINr,L <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTI'_RS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />SUB TOTAL $ <br />T— <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />' <br />PERMIT 5 <br />TOTAL FEE $ <br />' <br />TOTALFEE S <br />' -- <br />run urri" UJC <br />FRONTSET BACK <br />CAI\LT] <br />REAR SET BAOK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT HO. <br />USEZONE <br />LOT AREA <br />VACANT S'TE <br />FEES <br />VALUATION <br />FE—�_ <br />BUILDING <br />_ <br />I <br />T`TPE 01''JNTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />o[CRM)p <br />rro Oi fN/FHMGUNOs <br />PLUMBING <br />' <br />' <br />MECHANICAL <br />SIZE OF BLOC. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERSRE07 HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />I <br />STATE BUILDING SURCHARGE <br />_ <br />' <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />—� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />