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APPLICATIGA FOR CONSTIRUCT.JN PERMIT <br />the Ewrpmen TO BE COMPLETE" IK INK-PLS.lSE PRINT <br />CITY OF <br />eve rett f HEATING SYSTEM: U (!AS ❑ FLECTRIC ❑ <br />BUILDING DEPARTMENT L- <br />259.8810 <br />i DEMOLITION <br />COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />Gerald Lasley <br />1708 63rd St. <br />Everett <br />98203 355-1093 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />CITY ZIP PHONE <br />GENERAL CONTRACT OR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />Everett Builders, Inc. 5606 Evergreen Way Everett 98203 353-7161 EUREB*301PH <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSER <br />CLASS OF WORK <br />NEW I ADDITION ALTERATION X REPAIR DEMOLITION WMnsmvF/FRPI INSERT I 1 RI III nIMM RO TvAnnK, <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK 2967.00 <br />Mark Decker - 353-7161 <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Reroof (partial approx. 5 sq.) and gutters <br />and <br />downspouts. <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 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 />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR CDPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT , BLOCK of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />Tax account 0 5317-C :-020-0207 <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 />CONTRACTORS LAW 18.27 RCW AND 295.200 WAC. <br />SIGNATURE OFCONTRACTOR OR AUTHORIZED AGENT DATE <br />`BUSIN <br />PROJECT ADDRESS <br />APPLICANTS ITIT SS LICENSE NO AND BUSINES; NAME <br />A <br />PLUMBING <br />ME-HANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLO-IET (TOILET) _ _ <br />BATHTUB <br />_ _ <br />; <br />A/C-AJHNDLG UNITS-H.P. <br />, <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />_ <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />DISHWASHER <br />, <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />i <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />, <br />CXHAU3T FAN <br />, <br />SINK (SERVICE -BAR. ET(..) <br />, <br />, <br />SUBTOTAL $ <br />_ _ _ SUB TOTAL $ <br />PERMIT $ <br />' <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Ilr <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- - <br />PLUMBING <br />MECHANICAL <br />-- - <br />r— <br />--- <br />i <br />IYPf IXCOATS ALLDWABI[ <br />TYPE IXLONSI ACTUAL <br />or[uwMr <br />cRan <br />Ao awvlun<uan <br />SIZE OF BLDG <br />FIG OF STORIES <br />BASEMENT <br />HEIGHT LIMITATION <br />i <br />ADDFIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS F. <br />REASON FOR SPRINKLERS <br />OTHER <br />Ii <br />I <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODL IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />� <br />Vr��— <br />