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APPLICAT(�N FOR CONSTRUC';- ON PERMIT <br />everett <br />CI Le Erpreon <br />CITY of <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION I i COMBINATION 1 BUILDING I.) MECHANICAL Il PLUMBING fa SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Johm"m 'To1IY ?G/i kWuRrT-r 4011 9hl?0J 3y3-,57 4t77 <br />TENANT T MAIL ADDRESS CITY ZIP PHONE I <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />W.1 MI1 <br />yLlo A -A— <br />- <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />❑ NEW ADDITION 11 ALTERATION ❑ REPAIR [I DEMOLITION I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRIDE OF WORK: <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE LA'ORK AND BOU RE FOOTAGE INVOLVED <br />w)oy/-, Jr_+^'ems <br />PROPOSED USE OF BUILDING <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 />GTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED'.Y ;:!Z <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FO i WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 B.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY 1S"OWN BELOW OR ATTACH FOUR C5PIE51 <br />LOT_ BLOCK OF <br />PROJECT ADGRES9 <br />,J <br />O / -77 <br />PLICANT CITY SINESS LICENSE NO AND BUSINESS NAME <br />� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />AIC-AIIINDLG UNITS-H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS_-B.T.U. M E.A. <br />' <br />LAVATORY WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />i <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />+_ <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />30 <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />'+- <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />' <br />- <br />I <br />I <br />, <br />I <br />, <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL E <br />i <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ 1 <br />TOTAL FEE $ <br />' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />I ] YES I I NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />, <br />TYPE OF CONST ALLOWABLE <br />IYPE OF CONST ACTUAL <br />U UIWT <br />NPv MUM UMnE <br />SIZE OF BLDO, <br />NO. OF STORIES <br />BASEME14T <br />❑ YES C1 NO <br />MECHANICAL <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS RED D <br />O YES ❑ NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMIUTION <br />STATE BUILDING SURCHARGE <br />) <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC. BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />