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APPLICAT.ON FOR CONSTRUE. iION PERMIT <br />everelt <br />Ererpreen CI e <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />u DEMOLITION I I COMBINATION i i BUILDING MECHANICAL I PLUMBING SIGN <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />Own -ea - <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I <br />0u.4fe <br />MECHANICAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />I <br />n Mcw IL AnnITInN I I AI TFRATION I I REPAIR I- I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMOC ONLY <br />CONTRACT PRICE OF WORK: <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSEDUSEOFBUIL ING <br />G Q <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 31VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />3— /y^- <br />O <br />� �//, 1�W'i' <br />LEAS SCR PTION OF PROPERTY ISHOWN BELOW OR ATTACH Town COPIES) <br />Lor� j� BLOCK of <br />ZLP #AjP <br />"� <br />PROTECTADDRESS _ <br />/ <br />AP (CANTS CITY BUSINESS LICENSE NO ANDBUSINESSNAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />_�(�_ <br />AYC-AIHNOLG UNITS-H.P. <br />FORCED AIR SYSTEMS- S.TU. M E.A. <br />I <br />; <br />LAVATORY (WASH BASIN) <br />I <br />_ <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />_� <br />' <br />CLOTHESDRYERS <br />' <br />KITCHEN SINK 8 DISP <br />AlLa <br />VLNTILATION FAN <br />DISHWASHER <br />_-t <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />_--T- <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />_ <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />_ <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />! <br />EXHAUST FAN_ <br />SINK SERVICE -BAR, ETC.) <br />' <br />I <br />1 <br />' <br />1 <br />I <br />I <br />' <br />SUB TOTAL <br />9 <br />i <br />_ SUB TOTAL $ <br />Ste_ <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />r <br />TOTAL FEE <br />$I <br />TOTAL FEE $ <br />' <br />FRONT �6'YE�TBACN <br />20 E <br />REAR SETBACK <br />u/taa <br />BIDE BETBAC� <br />PLAN CHECKNU ER <br />FEE GJr <br />RED' <br />J,! <br />USE ZONE <br />R`1 <br />LOT AREA <br />7 2,1110 <br />VACANT SITE <br />1A YES I I NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />60 <br />' <br />TYPE OF CBNST ALLOWABLE <br />V_ <br />TYPE Of WNW ACTUAL <br />ouuAACY <br />Iw <br />I NO Y 0IY um M111I <br />612E * BLDG <br />680S <br />NO. OF STORIES <br />BASEMENT <br />I I YES 19 NO <br />MECHANICAL <br />cl :wj <br />OTHER <br />tt'' qq C <br />CICCUPANCY LOAD FIRE 6PflNNLERS REDO <br />I VES ►Q NO <br />REASON OOR SPRINKLERS <br />HEIGHT LIFION <br />STATE BUILDING SURC: / )ROE <br />� <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />1A1 <br />PLANS APPROVED BY <br />�� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODEIS 3105 <br />PUBLIC WORKS <br />TOTAL <br />B <br />