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APPLICA ION FOR CONSTRION <br />PERMIT <br />IhB EvMr"n everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL.ADDRESS CITY ZIP PHONE <br />TENANT // MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />� c ej �2 �zfs ci9o7 `7� S? = L-vac�T 3s5-�2 c <br />ME:HANICAL CONNhQTGR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW V ❑ ADDITION � ALTERATION ❑ REPAIR. ❑ DEMOLITION ❑ WOCDSTOVE/FRPL INE'ERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT^RICE OF WORK: "J C/C)v <br />vlTim'p '-j�'"TJ y <br />CON TACT PERSON AND PHONE NO �1 <br />�YL. A.\ \�U K\�Snt,J t❑ ����ZC� <br />DESCRIBE WORK ANDCUARE FOOTAGE INVOLVED <br />:300 (T q <br />jCf e.P. t/.l <br />` <br />\ <br />PROPOSED USE OF BUILDING <br />-pa S'1'TU <br />W�Uv fll '1 <br />I ER EBY CERTI FY THAT I HAVE R EAD AN D EXAMI N E D TH IS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER', PECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTi fER&TATEORLOCAL LAW REGULATING CONSTRUCTION ORTHE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BYTHE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTOPS LAW 18.27 RCW AND <br />296.200 WAC, <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PA <br />APPLICANTS CITY BU81 99 LICENSE NO. AND BU91 S9 NAME 1 6 <br />LEGAL DESCRIPTION F PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />- <br />PROJECT ApORE84 <br />�v <br />U-� �'T <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- ST.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS- B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE- BAR, ETC,.) <br />/ <br />o <br />SUBTOTAL <br />S <br />_ SUBTOTAL S <br />PERMIT <br />$ <br />PERMIT $ <br />_ TOTAL FEE <br />� <br />$ <br />TOTAL FEE $ <br />FRONTSETBACK <br />PEAn SETBACK <br />SIDE SETBACK <br />PLANCNECK �7n6^^ ^ <br />GC1`�/) <br />11 <br />FE E�'�r� <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANTSRE <br />O YES 1I10 <br />// <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />(" <br />PLUMBING) <br />TYPE OF CON97. <br />ALLOWABLEJACIUAL <br />�. <br />OCCUPANCY GROUP <br />- <br />NO OF DWELLING UNITS <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BSMT. <br />IN <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED i4ES ❑ NO <br />HEIGIITLIMITATIUN <br />STATE BUILDING SURCHARGE <br />_ <br />APPLC N Af BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WGflKS <br />TOTAL <br />