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�1a3 <br />APPLICATILA FOR CONSTRUCT .ON PERMIT <br />the Eve 9 mn evefett <br />CITY ee <br />verett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK -PLEASE PRINT <br />I I DEMOLITION 11 COMBINATION I BUILDING LyMECHANICAL I)PLUMBING I SIGN <br />OWNER ` MAIL ADDRESS _ _CLIY ZIP PIIOEIE <br />CITY <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />mfim�lMECHANICAL <br />MA' DRESS <br />,1.�. <br />aZIP`—^—�q <br />E <br />�lALLF'' <br />E SE <br />�gIt <br />CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADOCESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE / <br />CLASS OF WORK <br />I I NEW I I ADDITION f ERATION I I REPAIR 1.1 DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR WTERlOR EA ODE�L ONL� <br />E OF WORM: ll....�i <br />FACE <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK I <br />+e <br />RE FOOTAGE INVOLVE <br />°c - �oL <br />PP POSED USE OF BUkObb! <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 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 />SIGNATURE OF CONTRACTOR Oh AUT IORIZED AGENT DATE <br />71) <br />0LllANliCITNlUSINF* <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />—' <br />PROJECT ADDRESS rvvr����'TTTL <br />�1 <br />/��' y11 <br />q- — 86 >Y_L <br />(� 1 <br />LINSE OBUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />—T— <br />WATER CLOSET (TOILET) <br />A/C—AJHNDLG UNITS—H.P. <br />BATHTUB <br />' <br />_ <br />FORCED AIR SYSTEMS—B.L . E.A. <br />; <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />T <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />i <br />VENTILATION FAN <br />i <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' — <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE A CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />j <br />FIREPLACE INSERT <br />) <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />; <br />1 <br />I <br />� <br />I <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />' <br />PERMIT $ <br />I <br />TOTALFEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />I I YE 8 1 1 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />-- <br />i <br />i <br />TYPE OF CORSI. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />IKCUMNCT <br />IIAouA <br />ABDITMTLLFMIAATE <br />SIZE OF BLDG <br />NO. ❑F STORIES <br />BASEMENT <br />11 YES (1 NO <br />MECHANICAL <br />' <br />-- <br />OTHER <br />1 <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />I l YES I l NO I <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />I <br />STATE ENERGY SURCHARGE <br />�— <br />i <br />GN ACCB <br />PLANS APPROVED <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />; <br />TOTAL <br />