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APPLICATIOrI FOR CONSTRUCTk JN PERMIT 0TRB Ewrgt"R TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: U GAS W ELECTRIC ❑ ___.___— <br />BUILDING DEPARTMENT <br />259.8810 <br />I DEMOLITION I I COMBINATION <br />nIAwFR MAIL ADDRESS <br />MAIL ADDRESS <br />BUILDING i i MECHANICAL <br />CRY ZIP PHONE <br />Etimil L­1`1• <br />CITY ZIP PHONE <br />_ S Ame . <br />ARCHITECT OR DESIGNER MAIL. ADDRESS CITY ZIP <br />PHONE <br />I I PLUMBING i I SIGN <br />LJ <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENSE <br />61 4c <br />MECHANICAL CONTRACTOR MAIL ADDRF i5 <br />CITY ZIP PHONE LICENSE IF <br />OLr net <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PIgNE LICENSER <br />CLASS OF WORK <br />- I ..IrI^" I I AI TRRATInM I RPPAIR I I DEMOLITION Y� WOODSTOVEIFRPL INSERT I 1 BUILDING RELOCATION <br />L.I Lam.. ............. ...._. _.._..__. <br />CONTACT PE SON ANU PHONE NO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE I <br />� �NVOLVED <br />1 <br />5i U <br />PRopo6ED9 ILDING <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 />IEGAL DESCRIPTgN OF PROPERTY I6NOWN BELOW OR ATTACH FWRCOPIES) <br />LOT_ BLOCK OF <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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />SIGNATURE FCONTRACTORORAUTHORIZEDALI I DATE Gliz�sl <br />X <br />PROTECT ADDRE65 <br />%ECT Clf±l s�• <br />Lky-, <br />APPLICANT CITYBUSINESSLCENSEIq AN006 SSN <br />lv <br />0 1 eee <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />I <br />AIC—A/HNDLG UNITS—H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />r'-- <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />13ACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />_ <br />SINK (SERVICE —BAR. ETC) <br />— � <br />I <br />I <br />SUB TOTAL <br />E <br />' <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT E <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />rvn �rnA.c uac <br />vLu. <br />FEE <br />RECEIPT NO <br />TBA <br />FRONT SECK <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CAECA NUMBER <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />I <br />BUILDING <br />' <br />TYPE OF CONT6 AUDWABLF <br />TYPE OF CONST ACTUALoctwMKr <br />Ap aOATIIIAF UKm <br />tAour <br />PLUMBING <br />SIZE OF BLDO. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' � <br />ADDITIONAL PUN CHECK <br />I <br />OCCI IPANCY LOAD FIRE SPRINKLERS REDD HEIGHT LIMITATION <br />I <br />OTHER <br />i <br />REASON FOR SPRINKLERi <br />STATE BUILDING SURCHARGE <br />� <br />PUBI IC WORKS <br />i <br />INTAKE BY <br />PUNS APPROVED BY <br />CITY OF 6ERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />:30 <br />