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_l <br />APPLICATIOw FOR CONSTRUCTWH PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION 01 BUILDING ^ ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />a ua 9 410 z <br />TENANT MNL ADDRESS CITY Pp PHONE <br />ARCHITECT DA DESIGNER <br />MAIL ADDRESS CITY TIP PHONE <br />LF/ERAL CONTRACTOR <br />MAILADDRESS CITY ZIP PHONE STATE LICENSE A <br />ME1CIIANr.ALCd11MCTOR <br />MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />PLIAA1BKi CONT1uCTOR MAN ADDRESS CITY ZIP PHONE STATE LICENSE It <br />CONTRACT PIK *OF <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OElK:IBBE WORK AND SOHARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />Alold <br />0-y a-sa - 3ca� <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 />PPIDPOSED USE OF OU LDK4 <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCNRTION OF PRDPERI V(WORN BELOW DR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK OF <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 />iPPLICATION 1S MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSINXTON LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGc DATE <br />CITY BUSINESS LICENSE NO <br />PLUmem <br />MECHANICAL <br />NO. TV" OF EOLNPMENT FEE <br />PE <br />NO. <br />ITEM <br />TYPE OF FIXTUIIE OR R <br />FEE <br />WATER CLOSET (TOILET) <br />AIC — AMMDL.G LIMITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER' <br />UNIT HEATERS <br />' <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />1 <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />' <br />' <br />' <br />EXHAUST FAN <br />I <br />I <br />' <br />SUB TOTAL f <br />SUB TOTAL f <br />' <br />PERMIT $ <br />PERMIT f <br />' <br />TOTALFEE $1 <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />rTMfMT STLLACK I REAR SETBACK <br />Lrj <br />HECHT LIMITATION <br />LOL <br />NO OF DWELUNG <br />UNITS <br />SIDE SETBACK PLANCHEC U'C'R FEE RECEIPT NO <br />�� -7a 0 <br />VACANT SITE rcci <br />❑YES ❑ NO BULDING <br />SIZE OF BLOW I <br />PLIABING <br />BASEMENT MECHANICAL <br />❑VES ❑ NO <br />ADDITIONAL PLAN CIIFCK <br />OTHER <br />STATE BUILDING. SURCHARGE I I I <br />PLANS <br />Rl <br />CITY OF EVERETT rueuC INOAKe <br />LOCAL SALES <br />TAX CODE IS 3105 1 TOTAL <br />