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DIE EVEr9mon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICiv(ION FOR CONSTR TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />O7 7?C-'�- 5714. eve <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />Perr�o /Ji'/� <br />GENERAL CONTRACTOR <br />MAIL ADDNE69 <br />COY 21P <br />PHONE LICENSE• <br />f err�o 6 /f <br />/6S.! Hwv <br />9�T/yNwood <br />7o%3-/sSs � em/Ad <br />17ZO <br />. <br />MECNANICALCONIRACTOR <br />MAIL AUDRE89 <br />LICENSE 0 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NEW ❑ AnnITInN ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINGRELOCATION <br />.. <br />TENANT IMPROVEMENT OR INIEPIOII REMODEL ONLY <br />CONTRACT PRICE OF WgIK ' 7. /S9 c� <br />CONTACT PERSON AND PHONE NO <br />��/�! /•roHY 7y3 iss5 <br />DESCRIBE WORK AND BOUARE FOD/ EINVOLVED <br />PROPOSEG UBE uILDING <br />/.'� <br />J <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS 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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR 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 10.27 �MRyCW AND <br />WAQ <br />SIGNATURE OF CONTRACTOR OR AUIJ.4PI/f.D AGENT DATE S•-� �Vy <br />X "%///.�/� r - <br />LEGAL DEBCRIPTgN OfOfQ PRIY EIBNOWN BELOW OR ATTACH FOUR GOPIE91 <br />�/I�AI 4��3 �yy <br />LOTr.ASl2.Y1 BLOCK_.,iL_ of ' E- <br />L P <br />•�F"�'�. P. ��S.0 ^O3��Q Cf�� <br />/1 7 7SY< Fuere 9 o3 <br />PROJECT ADDRESS <br />APP IGAN19CI1 YRUS1�16EN9ENO AN� NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC — A/HNOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— BT.U. M EA <br />_ <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS—BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN $INK B DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A 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 />SUBTOTAL , <br />f <br />SUBTOTAL i <br />PERMIT <br />f <br />PERMIT i <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />FRONT SETBACK <br />REAR SETBACK <br />b, <br />SIDE SETBACK <br />RANG ECK NUMBER `.�., <br />9 <br />fEl <br />RECEIPTNO. <br />UISEZONE <br />_� <br />LOT eREA <br />C ��O <br />VACANI BR <br />O YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of CANBT. <br />ALLOWABLE/ACT AL <br />OCCUPANCYOROUP <br />,�/_ <br />NO OF DWELLING UNITS <br />—� <br />PLUMBING <br />SIZE OF BLDG•/ <br />T� <br />NO OF STORIES <br />OYT. <br />Xl tJ <br />OCCLOAD <br />MECHANICAL <br />_ <br />OTHER <br />nAESPNINKLEASREOUIREO OVER O <br />HEIGHT LIMITAW� <br />STATE SISILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR�er 1/ <br />W <br />STATE ENERGY SURCHARGE <br />_ <br />PUBLICWORKS <br />TOTAL <br />oil <br />