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the Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.0810 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY Zip PHONE <br />JAI_, rA40j_.SF �iio y� 1��a3 SS 3 • F9J�G <br />4/0 MS <br />ARCHITECT OR OESIONLP MAIL ADDRESS CITY ZIP PHONE <br />`n- •-- i7_. _ %c_-.,.,. .►, A- 7nt<r- 9d 2el <br />�f� P <br />ME N NI A Cv ONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBINO CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />/j/og'e <br />CLASS OF WORK �/ <br />Fl Mrw fl AnnlnnN n AITFRATION 1][ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTE RREMODEL ONLY <br />CONTRACT PRICE OF WORK: J aObd <br />CONTACT PERSON AND PHONE NO <br />� <br />f ! <br />DESCRIBE WORKA DBOUARE i00U0EINVOLVEO <br />> ' <br />OPOSED UBE o< EDINO <br />�S/ L°/VCe <br />I HEREBY CER TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW I HE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER 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 I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />298.200 WAC. <br />SIGNATURE OF CONTRACTOR OA AUTHORIZED AGENT DATE 9-J/9 <br />X <br />LEGAL DEBCRIMION OF PROPERT' )SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />�'y1 <br />1 L. <br />APPLICANTS CITY DU I SSLIC-19EH ANDBUSINE NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET, JILET) <br />_ <br />A/C - AIHNOLG UNITS -H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- ST.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -ST.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 6 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />SACKFLOW PREVENTERS <br />OAS PIPING <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - SAR. ETC) <br />SUBTOTAL t <br />__ SUBTOTAL IS <br />PERMIT i <br />PERMIT <br />TOTAL FEE S <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />PLAN CHECK <br />TOTAL <br />UMEEM <br />FEE <br />F99 296*0 MEGRIM NO. <br />USEZONE <br />LOT AREA <br />VACANT 91TE <br />D YES O NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />5 <br />TYPEOCONST <br />ALLOWABLE/ACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />— <br />SIZE OF BLDG <br />NO OF STORIES <br />BE <br />DY <br />ON <br />occ Loeo <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REWIRED []YES OF <br />NFNIHT LIMITATION <br />STATE BUILDING SURCHARGE <br />S <br />APPUCATIONACI. BY PLANE APPR BY <br />WATOTAL <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />