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�a:WLY�• Si• ull�:.....'.iYC YI.:Ir:.vY�wLlI.J`J�YY�d.L'i�.:Sri:�iL'ii,Y4LV��.J1iLiJ�RiB/TTL:,WTU--•-•ui:n`lr::�ySili��L,J��..SA�1Pi"}/E�GL�1lSSTIE�L� <br />APPLICATIOLy FOR CONSTRUCTION PERMIT everett <br />Me ER igmn TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF }} <br />everett FIEATING SYSTEM; GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION f I COMBINATION i I BUILDING MECHANICAL I I PLUMBING I I SIGN <br />OVqER .`_ EMAIL ADDRESS CITY 11 PHONE I / <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR D�FR / MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR ^I6LfAAILRMMf11L GRJ, <br />59.5492 -355.77-742.2 <br />3G �I--�C <br />LITY <br />16 (J <br />ZIP <br />il2INN <br />?'�-m"�/94 � <br />LICENSE) <br />MECHANICAL CONTRACTOR mAlLbAftifftDougall <br />CITY <br />ZIP <br />PRONE? <br />LICENSER <br />Ewrs", WB11MIM1loD 98201 <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />y, <br />❑ NEW ❑ ADDITION XALTERATION I I REPAIR <br />I I DEMOLITION <br />I I WOODSTOVE/FRPL <br />INSERT <br />❑ BUILDING RELOCATION <br />/) <br />CONTRACT PRICE OF WORK "—J...l��.`�d � � <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WOOK AND SpUA E F TAGE INVOLVE <br />PROPOSED USE OF BUILDIN?—.Y�-I� <br />`j,�� <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 />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOP.L IANCE 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 />CON TRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED ACRNT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <br />- <br />PROJECT ADDRESS <br />��-If <br />Imo. �� <br />li -A <br />Il <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.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />T_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />?— <br />SINK (SERVICE —BAR. ETC.) <br />—T—_ <br />�— <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />/1' ; <br />TOTAL FEE <br />$ <br />TO rAL FEE $ <br />p <br />FOR OFFICE USE ONLY: <br />FRONT SET BACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />TYPEOf CONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />GCGuGA" <br />NO Gl OW(LONGLNITS <br />PLUMBING <br />eaalr <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />30 I— <br />ADDITIONAL PLAN CHECK <br />i <br />UCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />OTHER <br />i— <br />_ <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />3� <br />TAX CODE IS 3105 <br />I <br />