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mPEvmpmnn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIC,. AON FOR CONSTR6ZTION <br />PERMIT <br />et'vPTP11 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />ARCHITECTORDESIONER MAIL AODRFS9 CITr ZIP FHONE <br />GENERAL CONTRACTOR MAII ADOR[63 CITY ZIP PHONE LICENSE• <br />M .. mnu Ll wrnnernvneool INRFRT ❑ BUILDING RELOCATION <br />LJ NEW u AOOII IOn <br />TENANTIMPROVEMENTORMTER [MODEL ONLY <br />CONTRACT PRICE OF WORN <br />------- <br />CONTACT PERSON AND PHONE NO <br />pEBC RK AND SOUARE FOOTAGE — VE 0 <br />r7evl <br />O/POSED USEa UUILWNU <br />�n L'1l L'Vlf'I�/1 f n <br />^ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIEDHEREIN OR NOT. THEGRANTINGOFA PERMIT OOESNOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1027 RCW AND <br />296.200 WAC <br />SIGNATURE OF CONTRACTOR MI AUTHORIZED AGENT DATE <br />AP klCAUlTYBUSINES II EN9ERO ANDBIIINE NAME <br />LEGALD IPIIDN OP PR N BELOW OR ARACH fOJR CORES( <br />LOT BLOCK OF <br />—v <br />ORE — <br />PROIECCT <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC - NHNDLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- GT.U. M EA .0 <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -SITU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />--- <br />LAUNDRY TRAY <br />WATER HEATER <br />--- <br />CLOTHESWASHER <br />WOOD STOVE <br />- -- <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING _ <br />ROOF DRAINS - RAINLEADERS <br />EXHAUST AN <br />SINK (SERVICE - BAR ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />_ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />FRONT SETBACK NEAR SETBACK <br />$ <br />SIDE SETBACK <br />TOTAL FEE 3 <br />PLAN CHECK NUMBER F[E BFC[IR NO. <br />us¢zoNE <br />LOT AREA <br />VACANT SITE <br />YFS F! NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAROI <br />- ---- <br />TYPE OF CONS( <br />ALLOWLBLUACTUAL <br />OCCUPANCY GROUP <br />NO C'MELUNGURITS <br />SIZE OF SLOG <br />NO OF STORIES <br />BSMI <br />LY <br />OCC LOAD <br />FIRE SPRINKLERS REWIRED ❑YES CNO <br />HFKSHTLIMIIATION <br />APPLICATION AM BY PLAM9 APPR Br <br />KC <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />L? <br />[ <br />