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APPLICATIGA FOR CONSTRUCTkalN PERMI <br />Tim Evergreen everett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.0810 TO BE COMPLETED IN INK—PLE�ISE PRINT <br />II III DEMOLITION L /I I COMBINATION <br />� I I BUILDING IIMLECMHEATA1NIICAL iPLUMBING I I SIGN <br />E 11� 1\ eQ.lIR A. 110DRESl1 1 w 1 l,ri. ICIiI I_.�� w Z11-�L �ll VW PHO Il J �� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE 1'JiZJJ/y L,w/J <br />CLASS OF WORK �/ <br />1-1NRw I 1 AnnITION 17VLTERATION I I REPAIR ❑ DEMOLITION I I WOODSTOVE/FRPL INSERT 11 BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTflIKIR <br />CONTRACT PRICE W WORK: ` <br />REMODEL ONLY��JI <br />L -• <br />� U <br />CONTACT PERSON AND PHONE NO <br />DESCRIIIEVIPORK AND SPUARE FOOTAGE INVOLVED <br />4 <br />PROPOSED USE OFB INa <br />I HEREBY CERTIFY THAT I HAVE HEAD 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 DO°S NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 'HE 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 OR AUTHORIZED ARGENT DATE <br />I <br />(LA <br />K <br />LEGAL DESCRIPTION OF PROPERTY ISNOWN OELOVV OFrATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />• <br />APPLICANTSCI nUSINESSL 'Cr <br />E NVRD BUSINEEES5 NAME <br />PLUMBING <br />MECHANICAL — <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET( <br />I <br />A/C—AIHNDLG UNITS—H.P. <br />1 <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T E.A. <br />LAVATORY (WASH BASIN( <br />r <br />UNIT HEATERS—B.T.U. M <br />I <br />SHOWER <br />' <br />CLOTHES DRYERS <br />t-- <br />' <br />_ <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />r <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />1 I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE d CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />r <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEATPUMP <br />I <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.( <br />_ <br />r <br />I <br />r <br />I <br />r <br />� <br />r <br />I <br />' <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />, uo <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />' -- <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />I I YES I I NO <br />FEES <br />VALUATION <br />F_. •EE <br />BUILDING <br />PLUMBING <br />I <br />TYPE Of CONST ALLOWABLE <br />TYPE OF CDNST ACTUAL <br />IICCIPAIAY <br />eAPe <br />YO dPWfuI1q UXI1I <br />SIZE OF BLDG <br />NO Cf STORIES <br />BASEMENT <br />I I YES I I NO <br />MECHANICAL <br />' <br />OTHER <br />i <br />OCCUPANCY LOAD FIRE SPRNKI ERB REOD <br />I 1 YES I I NO <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />i <br />APPLICATION ACC BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />j <br />TOTAL <br />