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APPLICATII.N FOR CONSTRUCI .ON PERMqT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION O COM8INATION ❑ BUILDING �iIECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS � <br /> .S�S..3D �'(/�2�2F��J :�-��a t/ <br /> OWNER MAILAUDRESS CITY ZIP PHONE <br /> '��.2/�szJ J�/�'f'O %me.� SZOO G�v lz� 2F�{.j/ ��c/ 3S� 7/ 7/ <br /> TENANT MAIIADORESS CIiY ZIP �PHONE <br /> ARCHITECT Ofl OESIGNER MAILADDRESS CIiV Zlp PHONE <br /> GENEflALCONTRACTOR MAILADDAESS CITY ZIP PHONE STATELICENSEY <br /> C��- % <br /> �1ECHANICALCONTFACTOR MAILAUDRESS CITV ZIP PHONE STATELICENSER <br /> PLUMBING CONTRACTOR MAILAD�FESS CIN ZIP PHONE STATE LICENSE� <br /> 2 �'i 5 � O <br /> CONTRRCT PAICE OF WOPK <br /> HEATING SYSTEM: CaGAS ❑ ELECTRIC ❑ <br /> DESCflIBE WORK AN�SOUARE FOOTAGE INVOLVEO CONTACT PERSONANO PHONE NO. <br /> G 2/L — — <br /> ��„II�J /��! �/✓I�O I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDINO APPLICATION AND KNOW THE SAME TO 8E TRUEi AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFINING THIS TYPE OF <br /> LEGAIDESCRIPTIONOFPROPEqJy�SHOWNBELOWORATfACH7WOCOPIES) �'�'ORK WILL BE COMPLIED WITH WHETHER SPcCIFIED HEREIN OR <br /> NOT. THE GRA'J'iING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> !or BLOCk oF AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM F�UTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOqK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.Nl1MBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER,pDURE55,TELEPHONE NUMBER /C E X Ks/4i✓ �L —�/—/Y <br /> SIG E ORTI: <br /> CIN BUSINESS LICENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TVPE OF FIXTUpE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/FiNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � ,Z, UNITHiATERS—B.T.U. M �,�$' � <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS ' <br /> DISHWASHER � <br /> � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEhTER , � <br /> URINAL � WOOD STOVE � <br /> ORINKING FOUNTAIN i METAL FIFEPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � '=1REPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; �;AS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE , <br /> ' GAS PIPING � <br /> i EXHAUST FAN , <br /> � � <br /> i � <br /> � <br /> � , <br /> SUB TOTAL $ � SUB TOTAL $ ;� <br /> PERMIT $ � PERMIT S iOo <br /> TOTAL FEE $ � TOTAL FEE S 'OG <br /> FOR OFFICE USE ONLY: y�� <br /> FqONTSEIBACK REARSEiBACK SIDESETBACN PLANCHECKNUMOER FEE RECEIPTNO. <br /> usezoNe LOTAREA VACANTSITE FEES VALUATION FEE <br /> OVES ❑ NO BUILDING i <br /> HEIGNTLIMITATION NO.OFOWELLING SIZEOFBLOGlf.l. � <br /> UNITS � <br /> PLUMBING � <br /> OCWFANCY NO.OFSi0NIE5 OCCUPANTLOAD BASEMENT MECHFNICAL <br /> GPOUP <br /> ❑VES ❑ NO � <br /> FIREAURMREO'D REASW ADDITIONALPLANCHECK � � <br /> i <br /> OTHER I <br /> FIPE SPRINKLER REO'� REASON <br /> i <br /> STATE BUIIDING SURCIiARGE � <br /> TVPEOFCONST. PLANSAPPROVEDBV CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES ' <br /> DATE TAX CODE IS 3105 TOTAL ; <br />