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APPLICATICWI FOR CONSTRUCT"' 3N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />OWNER MAILADDRESS IM�ma-B 7�CITY ` zl' P PHONE <br />U <br />If . /, TIP PHONE <br />ZIP <br />GENERAL CONTRACTOR MAIL ADDRESS CITY Pf <br />PI ZONE STATF. LICENSE <br />MECHANICAL CONTRACTOR MAILADDREES CITY TIP <br />LICENSE II <br />PLUMBING CONTRACTOR MAIL ADDR�SS CITY 71P PHONE <br />1 �' % STATE LICENSE <br />ULM I MGT PRICE OF WORK <br />•� <br />/ /V � NW//ei`I Al n-7/��_ <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC El <br />WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHDNE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROP1U5ED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK _ OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI. 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 296.100 WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />X <br />5IGNARIRE DATE <br />CITY BUSINESS LICENSE NO <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 />' <br />A/C-AMNDLG UNITS <br />-.T_ <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER' <br />UNIT HEATERS <br />, <br />I <br />KITCHEN SINK 6 DISP <br />i <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />, <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />-�- <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />I <br />SINK (SERVICE - BAR, ETC.) <br />1 <br />GAS PIPING <br />, <br />' <br />EXHAUST FAN <br />I <br />I <br />I <br />; <br />I <br />1 <br />I <br />I <br />_ <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT E <br />I <br />PERMIT f <br />, <br />TOTAL FEE $ <br />' <br />TOTAL FEE E <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NI)M Ffi <br />FEF <br />RECEIPT NO <br />ZCi <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />BUILDING. <br />' <br />HEIGH1 LIMITATION <br />NO OF DWELLING <br />SIZE OF BLOGRI <br />1 <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />HMO OF STONES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />I <br />MECHANICAL. <br />OYES ❑ NO <br />ADDITIONAL. PIANCHr.CK <br />_ <br />1 <br />FIRE SPRINKLER REO'0 <br />REASON <br />OTHER <br />; <br />I <br />FIRE ALARM REOD <br />REASON <br />STATE BUILDING SIIRCHARGE <br />TYPE OF CONSi <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PURI IC WOOKS <br />I <br />LOCAL SALES <br />TOTAL <br />DATE <br />TAX CODE !S 3105 <br />