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APPLICATAN FOR CONSTRUCAON PERMIT <br />TIP EW ,D, everett <br />CITY OF e <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />DEMOLITION COMBINATION X BUILDING i MECHANICAL PLUMBING - SIGN <br />aANER MAIL ADDRESS CITY ZIP p E <br />Alf,� <br />TEN NT MAR.VDRE55 �I Clry ZIP PHONE <br />AR�JDA1nJ <br />CHITECT DR DESIGIIER MA0. Ao EBS CITY ZIP %pNE <br />PWMBINOCONTRACTOA MALA0O1E55 CITY ZIP PHONE LICENSEE <br />NEW YL ADDITION ❑ ALTERATION CI REPAIR I DEMOIrtInN "'I wnnncTnvcmool ikioci, n — I im.—•.,.—...... <br />TENANT IMPRDYEMENTOR INTER REMODEL OILY <br />CONTRACT PACE OF INOR.: ;<22 doo <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE AND F/po,icyG INIfV EO I / <br />A <br />PROPOSEDUSEOff) we / <br />_ y11`a�p,TT <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 HER71N 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 I COMPLY WITH THE STATE <br />SSIGNAGTORS LAW 18.27 OFCONTRACTOR OR AUIX)FUEO AGEA <br />AGENT DCE. <br />NRE1./7/9l <br />A <br />of <br />LE:•.IL DESCHIP1gN OF PROPERTY SHONN ULM OR ATTACHFWRCOP¢SI <br />LOT_ _ BLOCK of <br />S •,. n+'� <br />/; <br />///o 7 i <br />PRQIECTAT�DRF 5 J/ <br />t�/ � /��� ��L•�% <br />- <br />APPLICN SCITYBJSIIIESSL ISE NO ANO WSINESS 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-AIHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS -BTU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL $1 <br />SUB TOT A_: g <br />PERMIT <br />g <br />PERMIT g <br />TOTAL FEE <br />$ <br />TOTAL I'EE $ <br />---�— <br />FRONT SETBACK <br />REAR SETBACK <br />t %T-mz Cr <br />SIDE SETBACK <br />- <br />RAN HFCKI LANER <br />13( <br />fEE �` <br />-- <br />RECEIP NO <br />visa <br />USE zaryt'�-I <br />b <br />LOT AREA <br />AW SRE <br />❑ YES NO <br />EES <br />VALUATION <br />FEE <br />BUILDING <br />00 <br />/ 1S,- <br />TTRamxsT. ALLowAMF <br />�,(SYlA <br />Trn ataxsT Mtua <br />E15T <br />D¢IIFML. <br />LED. <br />KoownllmlNm <br />PLUMBING <br />W- <br />SIZE OF BLW. <br />NOOFSTa1IES <br />BASEMEN <br />I] YES x N0 <br />MECHANICAL <br />OCCOPANCY LOAD FIRE SPRINKLERS REDO HEXBRLMTATKN <br />118 ❑ YES '.-, NO <br />REASON FOR SPRINKLERS <br />SPKIAIXLCCS ALSEFAO$ 74fft <br />OTHER <br />BUILDING SURCHARGE <br />Li <br />STATE ENERGY SUPSHARGE <br />APPLICKTIDNADD. .BK <br />NAY'L <br />PLANS PPD"ED�'' <br />/ /'l�l <br />CITY 0FEVERM <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />; �Q <br />