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APPLICATIL A FOR CONSTRUC7.4)N PERMIT <br />everett ' <br />the <br />EmrOleen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />I I DEMOLITION COMBINATION /61UILDING I I MECHANICAL I i PLUMBING CI SIGN <br />OWNER MAR ADDRESS CITY ZIP PHONE <br />)Zp$ yl'//So.7 y- zy'w�sa 6ye",it 1&r0 9b�n� 3 39- '39•_ f= <br />TENANT I MAR ADDRESS CITY ZIP PHONE <br />ARCHITECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL TRACTOR MAIL AGGRESS CITY ZIP PHONE LICENSEE AT <br />,�_..ft <br />S• aio9 /�rSt-aSd-Yyi3 �3 9P�3 <br />M GHANICALCON RACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBINOCONTRACTO'L MAR ADDRESS CITY ZIP PHONE LICENSE IT <br />CLASS OF WORK � O t�' <br />-, ..�.., n AnnITInk. I 1 ♦1'lFPATInAI I; FPAIR �/ I-, DEMOLITION 1 I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO. <br />/ <br />CONTRACT PRICE OF WORK: <br />D%F,/$CR�KT�E WORK AND SQUARE FOOTAGE INVOLVED <br />/1NDJITc �l`~ e S e p ram <br />PROPOSED USE OF BUIL NG �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 />��� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK OF <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 OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PF'FORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I ..OMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />_ <br />SIGNATU/RREE OFFCC,ONTRACl/OO'll ORAAJUTHORIZED AGENT DATE <br />7-G /9d <br />PROJECTADDRESS <br />�, lr <br />W <br />_yTLLcC. <br />APPLICANTS CITY BI SINE63lOE NSF. O ND 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 />I <br />A/G—A/HNDLG UNITS—H.P. <br />BATHTUB <br />' <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 />I <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />I <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />) <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE 6 CHIM EY <br />' <br />URINAL <br />DRINKING FOUNTAIN_ <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN r— <br />' <br />HEAT PUMP <br />' <br />_ <br />SACKFLOW PREVENTERS <br />; <br />_ <br />GAS PIPING <br />ROOF DRAIN AINLEADERS <br />I <br />EXHAU5 AN <br />SINK (SER CE-BAR, ETC.) <br />' <br />I <br />' <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL S <br />PERMIT <br />E <br />I <br />PERMIT E <br />' <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />1' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PIAN CHECK NUMBER <br />ILL <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />0 <br />7 �Z ; O d <br />I <br />11 YES f l NO <br />TYPE OT COAST ALLOWABLE <br />TYPE OF CORSE ACTUAL <br />aWMKr <br />immmulw Ays <br />°A01p <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />CI YES Cl NO <br />OTHER <br />OCCUPANCY LOAD FIRE 6PRNKLERS RE00 <br />HEIGHT LIMITATION� <br />f) YES I 1 NO <br />STATE BUILDING SURCHARGE <br />' <br />STATE ENERGY SURCHARGE <br />I <br />REASON FOR SPRINKLERS <br />APPLICATIONACC, BY <br />PLANS APPROVED BY <br />CITYOFEVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />76, ' Cv <br />TAX CODE IS 3105 <br />TOTAL <br />