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APPLICATION FOR CONSTRLoCTION <br />PERMIT <br />the Enrgreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Z1YY, zoNNLC Rr,;j q05-86"A SY 5E Evcre. W 353-5115 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ANCHRECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />rIENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />�000� CptoST, Z.NG deR Iy027-Nwssr <br />GRamnes <br />M"-1 FIG "_qLA <br />NEiNRMBRE'lrARRlICR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />1121.7 -1,Q+h sT <br />Nt 1.K 5+even5 <br />C(&Xl' <br />3349242. <br />PLUMBING CONTRACTOR MAIL ADDnr 5s <br />CITY <br />ZIP <br />_ <br />PHONE LICENSE• <br />CLASS OF WORK <br />g NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION CI WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPFIM'EMENT OR INTFNIOR REM^]EL ONLY <br />CONTRACT PRICE OF WORK I�•a�Sy <br />XJ//� //�� <br />15,56`/ <br />CONTACT PERSON ANDPHONE NO. <br />DESCRIBE WORK AND�/SOWRE FOOT OEINVOIVEODQ <br />?POS NO <br />u) sa <br />D 9E0OF BUILOf a- • <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAOINEO THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT AL. PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK PILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRAN, ING OF A PERMIT DOES NOT <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 <br />THIS TO PERFORM THE WORK FOR WHICIH ZED AP BLIC TN IIOS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />298.200 WAG <br />G e <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEV AGENT DATEII_�/I,��-IJ <br />LEGAL DESCRIPTION OF PROPER" ISHONN BELOW OR ATTACH FOUR COMIF% <br />�. a <br />LOTBLOCK OF - - <br />I' <br />NE r} NW 4 SICG I B "iL'yp_$ 55 <br />/w , I . �` <br />l _0.SC_Q.D[[F-P YI6W '�S <br />PROJECTPROZECT AD <br />APPLICANTS CITY BUSINESS LICENSE O AN BUSINESS 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 (TOILET) <br />A/C - A/HNDLG UNITS - H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS -ELT.U. MEA <br />LAVATORY (WASH BASIN) <br />UNITHEATERS-BT.U. M <br />SHOWER <br />CLOTHESDRYERS <br />KITCHEN SINK 6 DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK (SERVICE - BAR. ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />_ <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTAL FEE <br />t <br />_ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />J / <br />USE ZONE <br />r% `1 <br />LOTAREA <br />& LA <br />VACANTS2 <br />O YEB /7 N0 <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />'s bO <br />/n <br />/ <br />ov <br />TYPE OF CONST. <br />ALLOWA -ACTUA '.I <br />IN) <br />OCCUPANCYOROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />912E OF BLDG <br />qbo s.F. <br />NO.OF STORIES <br />BRMT <br />u r <br />vcN <br />OCG LOAD <br />N <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES NO <br />HEIGHT LIMITATION <br />G I F <br />STATE BUILDING SURCHARGE <br />APPLICAIION ACC BY PLANS APPR BY <br />I he 3 <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />05 <br />EaD <br />