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fhD Er910,9p.9 <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.6810 <br />APPLIC).'(ION FOR CONSTR TION <br />PERMIT <br />(•VPIIHI <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADDRESS CITY IW PHONE <br />rfed 1�1�ii) �ns� �121 I�ln `TT sE tuerc i-•-7153 <br />TENANt MAIL AODRES9 CITY ZIP PHONE <br />ARCHITECT OR pE91GNFR MAIL ADORE98 CAT♦ LP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />ou�r�e r <br />MECHANICAL CONTMCTOR MAIL ADORERS CITY NP PHONE LICENSE <br />PLUMBINCCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />TENANT IMPROJEkM ORINTERIOR REMODfiL O1NIIY /yam <br />CONTRACT PRICE OF WORK (p I-�, Ug�. µJ <br />CONTACT PERSONANDPHONE NO <br />DESCRIBE WORK AND SQUARE FOOIAG INVOLVED <br />e <br />PROPOSED USE OF BUApINO <br />�. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINEO THIS APPLICATION AND <br />KNOWTHESAMETO BETRUE AND CORRECT. ALL PROVISIONS OF LAWSAND <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIED HEREIN OR NOT. THE GRANTINGOFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296 200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x 6 z l� a,P sizow <br />APPLICANIS CITY BUSINEBSIIi ,T NC AMp RUSHERS NAMEe c T1 aa� <br />lfipEBCRIPI NOF PROPERTY BELOW OR ARM:H FOUR COMESORDINANCES <br />u <br />LOT LO BLOCK OF CTQC L' <br />- <br />PROJECTADDRESS ------ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />�k <br />WATER CLOSET ITOILET) <br />A/C — AVHNDLO UNITS —H.P. <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS— BT.U. M EA <br />_ <br />LAVATORY (WASH BASIN <br />UNIT HEATERS —STD. M <br />SHOWER <br />1 <br />CLOTHESORYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />URINAL <br />WOOD STOVE <br />METAL FIREPLACE S CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR GRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR ETC I <br />_ <br />SUBTOTAL <br />6 <br />SUBTOTAL t <br />PERMIT <br />6 <br />PERMIT i <br />TOTAL FEE <br />f <br />TOTAL <br />FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CM Ck NUMSLR <br />S! • <br />kLClIPT NO. <br />SUZONE <br />R' I <br />LOT AREA <br />o <br />VACANT SITE <br />XYES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of CON81. <br />ALLOWABLE,AciU(IL <br />v <br />A fOGRV <br />OCGUPANCYOUP <br />NO OF DWELLING UNITS <br />' <br />PLUMBING <br />SIZE OFSLDO <br />1 11 G <br />J-�42.L <br />NO.OFSTORIES <br />I <br />I BBMT <br />N <br />OCC LOAD <br />N A <br />MECHANICAL <br />OTHER <br />,�ZZ <br />FIRE SPRINKLERS REOULIED 0 YES rJ NO <br />HEIGHTLIMMFAAII?N <br />tl <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC By xAN! PPR er <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />