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APPLICATIvN FOR CONSTRUC'11ION PERMIT <br />everett <br />Evmpeen r <br />CI e <br />CITY Of <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />IXDEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br />k OWNER MAR ADDRESS M CITY PHONE <br />%,A RRY_SP4`wwAp, 3�3 7-rmsTSF s Fd. FSIP oa 35s. GZ30 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />SIP <br />PHONE <br />j{ <br />¢ GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SIP <br />PHONE <br />LICENSE P <br />x <br />j[ S r.F <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SIP <br />PHONE <br />LICENSE P <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SIP <br />PHONE <br />LICENSE F <br />y <br />v <br />❑ NEW I 1 ADDITION ❑ ALTERATION FI REPAIR IXDEMOLITION P WOODSTOVE/FRPLINSERT I.I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMOPTEL ONLY <br />CONTRACT PRICE OF WORK: <br />CONTACT PERSON AND PHONE NO <br />SvFKI� 1- <br />DESCRIBE WORK AND fiOTARE FOOTAGE INVOLVED <br />ok <br />rilleE Fkw (or <br />PROPOSED USE OF BUILDING , I <br />[LQLL DOWN 14 R4Ce AA)V0 , AIK 20 <br />1 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 />AU CHORITY 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 AUTHORISED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT_ BLOCK OF <br />see Q a l l"")— <br />PROTECT ADDRESSFiJiF'Cie <br />,I��p Cr' �C <br />O <br />pgOq <br />O/� J <br />APPLIC NIS YBUS ESS LICENSE 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 />WATER 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 />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />WATER HEATER_ <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />r <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />1 <br />EXHAUST FAN <br />SINK SERVICE -BAR. ETC.) <br />' <br />I <br />—T <br />I <br />I <br />SUB TOTAL $ <br />i <br />SUB TOTAL S <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />I <br />TOTAL FEE <br />$ <br />' <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 />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />TYPE OF CONST ALLOWABLE <br />TYPE DF CONST. ACTUAL <br />OnIPAIKr <br />p10UF <br />K°a°Kaw°IAnn <br />SIZE OF BLDG NO OF STORIES <br />OCCUPANCY LOAD FIRE SPRNKLERS REDO <br />f I YES Cl NO <br />REASON FOR SPRINKLERS <br />BASEMENT <br />I I YES ❑ NO <br />HEIOHTLIMITATKM <br />MECHANICAL <br />' <br />OTHER <br />I <br />STATE BUILDING SURCHARGES <br />5 n <br />STATE ENERGY SURCHARGE <br />APPLICATIONACC BY <br />U,\ <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALTS <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />L ) <br />