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APPLICATKA FOR CONSTRUCTION PERMIT <br />the EYergro , <br />CITY OF <br />everett <br />BUILDING DEPARTMFNT <br />259-8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING <br />�ppER ,,// MAIL ADDRESS CRY ZIP <br />PHONE <br />/cad Hu/n!s /3ty 7L/sr rvr 9gZ�3 7S.- 3?i� <br />TENANT MAIL ADDRESS CITY 21P PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAR ADDRESJ CITY ZIP PHONE LICENSE <br />. MIT ACTOR MAIL ADDRESS <br />/ / r 7 ... J <br />I <br />SIGN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASSOF WORK y' <br />I. 1 NEW ADDITION /Y ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK: OQ <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOURE AFOOlA E INVOIVEO / <br />PROPOSED USE OF BUILDING <br />S t <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 />OTHER STATE 09 LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIOI L 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 16.27 RCW AND 296.200 WAC. <br />SIGNATURE OFF CONTRACTOR OR AUTHORIZED AGENT DATE <br />[f <br />• 4,tL A r! <br />LEGAL DESCRIPTION OF PROPERTY fSHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESSAICIENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAIER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK R DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINA! <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />' <br />) <br />I <br />I <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />I <br />TOTAL FEE <br />$ <br />TOTALFEE $ <br />'0D <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />- <br />— <br />—� <br />i <br />TYPE Of CONST ALLOWABLE <br />TYPE IX CONS ACTUAL <br />mcup", <br />6 M, <br />Ao d vATUWowns <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />YES NO <br />MECHANICAL <br />OTHER <br />OCCUPANCY LOAD FIRE SPRNKLERS REGO <br />YES NO <br />REASON FOR SPRINKLERS <br />HEIOL T LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS APPROVE[) By <br />PUBLIC WORKS <br />TOTAL <br />