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APPLICATION FOR CONSTRUCTION PERMIT eveTel' <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> Tho EYNIoRwR <br /> CITY OF <br /> everettf HEATING SYSTEM: J�A3 U ELECTRIC U <br /> BUILDING DEPARTMENT -- - <br /> 259.8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY -- ZIP ----_— PHONE <br /> TENANT MAK.ADDRESS <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERA(CONTRACTOR CITY TIP P <br /> MAIL ADDRESS I E LICENSE( <br /> J� _f�Pt [lo_Mr��r >K✓1' y�—��r.Ewy�QsB� <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY 211' PHONE IKRNSE■ <br /> PIUMBWG CONTRACTOR MAK.ADDRESS CITY ZIP PHONE LICENSE <br /> CLASS OF WORK <br /> I i NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> �K CONTACT PERSON AND PHONE NO <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE WORK AND SOIIARE FOOTAGE INVOLVED <br /> 'tuSu -� <br /> PROPOSED USE OF BIIKDINO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTION OF PROPERTY(SHOMBELOWOR ATTACH FaIR OLmIEsI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK OF 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 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 /> SIGNATHFIEOI CONTRACTOR(0I AUTHORIZED AGENT DATE <br /> X <br /> PROJECT ADDRESS — -- —' <br /> ' VO )OL A 'I CANT. .ITY ISIHLSSII:ENSE, AND COSINESS NAME <br /> PLUMBING c ME ICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ' A/C–AMNOLG UNITS–H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS–B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) 1 UNIT HEATERS–B.T.U. M 1 <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 6 DISP ' VENTILATION FAN <br /> DISHWASHER _ ---' RANGE HOOD <br /> WATER HEATER_ ' <br /> LAUNDRY TRAY WOOD STOVE ' <br /> CLOTHES WASHER , METAL FIREPLACE 8 CHIMNEY —!— <br /> URINAL <br /> DRINKING FOUNTAIN _ - FIREPLACE INSERT <br /> FLOOR DRAIN NEAT PUMP ' <br /> _ ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> -I <br /> ROOF DRAINS–RAINLEADERS _ �_ EXHAUST FAN <br /> SINK(SERVICE–BAR,ETC.) <br /> 1 �T <br /> _ 1 <br /> T 1 <br /> i SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ I .-. _ PERMIT S <br /> i TOTAL FEE S ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: _ <br /> FRONT SETBACK REAR SETBACK 610E SETBACK PI AN CHECK NIIMOER I[I. RECEIPT NO <br /> I <br /> USEZONE LOT AREA VACANT SHE FEES <br /> VALUATION FEE <br /> ' <br /> BUILDING ' <br /> TYPE OF CONTS AROWABI E TYPE OE COIRt ACIITAI KCONM[Y I omilwlAill _. __ I <br /> 41°N PLUMBING ' <br /> SIZE OF SLOG NO OF STORIES BASEMENTs� <br /> MECHANICAL <br /> OCCUPANCYIOAD FIRE SPP, ,ERSREUC HEIGHT I IMITATION PIAN CHECK <br /> .n <br /> OILIER __ I <br /> REASON FOR SPRINKI ERS — _ <br /> STATE BUILDING SURCHARGE ' <br /> - _ 1 <br /> MANE BY PLANS APPROVED BY CITY OF EVERETT PURI IC,WORKS <br /> LOCAL SALES <br /> S <br /> TAX CODE IS 3105 IOLAL <br />