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Ri �y"I <br />xy <br />>gCCA <br />I< C7 <br />H0 <br />oxo <br />.O H 'U <br />yNC <br />z <br />o� <br />OH <br />=08 <br />n• � <br />H <br />z H <br />y H <br />r yH <br />g H <br />A 17 fA <br />z y r4 <br />y OE4 <br />c:l <br />APPLICATIGA FOR CON➢STRUC7.` -A PERMIT <br />,LTTIn <br />EYBIpIPBR <br />CI <br />CRY OF <br />everett <br />Vj� <br />DEPARTMENT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />259 8EI0 <br />259 Be10 <br />BUILDING <br />MECHANICAL <br />PLUMBING <br />SIGN <br />DEMOLITION COMBINATION <br />OW/ II- MAIL ADDRESS <br />N <br />CRy <br />RIP <br />PHONE <br />TENANT MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />— <br />O!MlFRAL CONTRACTOR MAR ADDRESS <br />- — _- GIN <br />SIP <br />PHONE <br />LICENSE A <br />. <br />/Vl i. ! ! (r (. <br />CITY <br />TIP <br />PHONE, <br />IICENSEF <br />MECHANICAL CONTTUK:TOiT MAR ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK wY nliTnVF,FRPL INSERT i..I BUILDING RELOCATION <br />NEW IT AUUIRIVN nu cnn,,.n. <br />..�. .....1 __...__. <br />_ <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />bait(' nIGN✓ <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE Oi YNORI: <br />DESCRIBE WORN ANOSOUARE FOOTAGE INVOLVED PAJDYStln <br />D Uplfa( <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL OESCRIPTKkN OF PROPERTY ISNOYM BELOW OR ATTACH FOUR COPIES/ <br />Lot'. `/ BLOCK of <br />"'� <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />ANY <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OTHER STATE OR LOCAL LAV, REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE V OAK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIDNAIURE O CONTRACTOR OR AUTHORIZED AGENT DATE <br />i <br />I HE/oBM_w_ES_SNAME <br />APPIIrANT`. CITY PUSINF SSI'' I,, N,A <br />Pno.ECTADDRESS <br />PLUMBING <br />ITEM <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />A/C-A•HNDLG UNITS-EI I" <br />I <br />FORCED AIR SYSTEMS-B T U. M E.A. <br />; <br />BATHTUB <br />_ _ <br />UNIT HEATERS-B.T.U. M <br />I <br />LAVATORY (WASH BASIN) <br />_ <br />CLOTHES DRYERS <br />' <br />I <br />SHOWER <br />KITCHEN SINK f DISP <br />I • <br />VENTILATION FAN <br />r— <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />1;' <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />c -� ! •- <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR GRAINHEAT <br />PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVIr.E-BAR, ETC.) <br />_ <br />I <br />SUB TOTAL <br />f <br />SUB TOTAL S <br />PERMIT <br />$ <br />Y' <br />PERMIT f <br />I <br />TOTAL FEE <br />f <br />>' -" <br />TOTAL FEE f <br />!-' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK E <br />�oA.ts>. <br />PUN CITE KNMBER FEE <br />�3s�5 <br />RECEIPT NO <br />id <br />try <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />USE ZONE <br />AREA <br />BUILDING <br />•��7 w <br />f,I <br />�Z <br />aLOT <br />vc5 NO <br />TYn DF CONST MLOWABLE <br />JIM OF CONST MIUM <br />x,r,wKrI <br />G." <br />un <br />I <br />PLUMBING <br />5M W glDO <br />NO O STORIES <br />BASEMENT <br />MECHANICAL <br />` ' — <br />q 5F f <br />YES X NO <br />OTHER I <br />� ' c <br />HEIGHT IMpA.AI� <br />OCCUPANCY I CAD FIRE 6PRNKlEPSPEO'D <br />' <br />YES 0t NO <br />_ __ _14_ O <br />STATE B LDING SURCHARGE <br />'T <br />STATE ENERGY SURCHARGE <br />' <br />' <br />REASON FOR SPRINKLERS <br />CITY OF EVERETT <br />PUBLIC WORKS <br />/ <br />r , <br />APPLICATION ACC BY <br />PLANS APPROVED BY <br />�L <br />LOCAL SALES <br />r,J7ry7C <br />)N A <br />7 P <br />TAX CODE IS 3,05 <br />TOTAL <br />