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APPLICAI rON FOR CONSTRUo..TION PERMIT <br />Y- <br />the ERBryrPBR <br />CITY OF <br />everett - e <br />BUILDING DEPARTMENT <br />259-8810 TO LE COMPLETED IN INK -PLEASE PRINT <br />DEMOLITION X COMBINATION BUILDING L MECHANICAL i PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE rLOO <br />A. <br />ARCHITECT OR DLSIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENEiAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE,ST.100/ LICENSE II <br />A. <br />CONTRACTOR MAIL ADDRESS CITY <br />Cm <br />CLASS OF WORK -- <br />:kNEW L I ADDITION L i ALTERATION REPAIR 1 DEMOLITION WOODSTOV&FRPL INSERT ❑ B <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. UILDING RELOCATION <br />CONTRACT PRICE OF WORK: ram- &/f', /Ili <br />SCRIDE WORK AND SQUARE F TAOE INVOLVED <br />L0rM C4 -Z4COI <br />iD <br />C.OArS_;ucT10AI <br />_ <br />PROPOSED USE Cs BUILDING <br />t'' '' ' <br />l <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />wa l-i AM L c <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY ISHOR ATTACHFOURCOPIESI <br />WN BELOW O <br />LOT 8L6:k of <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />_ <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE <br />Q P (��4L`1AEp/ <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 />.�— <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLWATION 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 />A-41— JVF,-!5T y UEcGPu��T <br />x <br />oy /� �E.S <br />PROJECT ADDRESS �7 <br />7-30 1 / y� s'�EG% <br />APPL CANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AJC-AJHNOLG UNITS-H.P. <br />'j <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />, <br />. <br />.11 <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />^ <br />SHOWERCLOTHES <br />IF <br />DRYERS <br />, <br />KITCHEN SINK DDISP <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />/ <br />DISHWASHER <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />— <br />• <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />HEAT PUMP <br />, <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />; <br />/ <br />GAS PIPING <br />I <br />ROOF DRAINS—RAINLEADERS <br />I <br />�.. <br />EXHAUST FAN <br />, <br />•� <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />I <br />SUBTOTAL $ <br />' — <br />SUBTOTAL $ <br />PERMIT $ <br />...r— <br />PERMIT $ <br />y <br />TOTAL FEE $ <br />' -- <br />TOTAL FEE $ <br />FRONT SETBACK <br />I <br />REAR SETBACK <br />1 <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />ZJ <br />�a <br />S' <br />?01 4,V4'YV <br />3;ILS ce <br />33310 <br />USE ZONE <br />Lot F <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />L„1 YES NO <br />BUILDING <br />2 V 117 <br />' <br />TYPE Dr CONST. AILQWABLE <br />TYPE <br />DMuft <br />CONST ACTu <br />T WT MIIMU urns <br />RWJJ <br />��V/ <br />PLUMBING <br />61ZE aF B-CG. <br />GfIQIA <br />NO OF STORIES <br />� <br />;EMENT <br />; YES of NO <br />MECHANICAL <br />_ <br />OCCUPANCY LOAD FIRE SPRINKLERS OD 1:7�E.�GOTLIMITATION <br />OTHERXNO <br />BUILDING SURCHARGE <br />LI �N�11 <br />REASON FOR SPRINKLERS <br />APPLICATION ACC. BY Rh ROVEDeY CITY OF EVERETT <br />LOCAL SALES <br />[TAX <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />CODE IS 3105 <br />'2W ;' <br />