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APPLICATIL A FOR CONSTRUC1.ON PERIMIT <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: 'Tj u _� U !i O y l L`i-L, —� I\, d-4 K. <br />OWN: <br />MAILAODRESS <br />CITY <br />ZIP <br />PHONE <br />(2"T cAG-0 IrrLk— <br />30.30 Noa- AVE <br />LvLa tF-r tr <br />9Ef203 <br />259-�2c12 <br />TENANT <br />MAILADDRESS <br />CITY <br />TIP <br />PHONE <br />5R-1e AS <br />0c-vE� <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />0 HLI.I <br />CITY ZIP <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY In PHONE STALE LICENSEL <br />CONTRACT PRICE OF WORK / 37 <br />E1 153 c , <br />HEATING SYSTEM: ❑ GAS "ELECTRIC ❑ <br />DESCRIBE WOR AND SQUARE FOOTAGE I V LVED <br />�Suo c 2s no vc -7, In N 2 rvn G <br />CONTACT PCRSON A D PHONE NO <br />Jys <br />l rJIV PAL:<A06 OVA(— Li NG('S Rf—PL—Act_ <br />NP_ uJ <br />LL: 14 r-t4` F.I wI A-S <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 />X \ � L j ,t C�7/ q [e <br />SIGNA RE DA E <br />PROPOSED USE OF BUILDING <br />0 FFL t=( S <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER -- <br />CONSTRUCT10N LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF PXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (7 YLET) <br />I <br />A/C—AMNDLG UNITS <br />�— <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />—;— <br />SHOWER <br />I <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP _ <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />I <br />-T <br />SUBTOTAL $ <br />SUBTOTAL $ <br />C ; <br />PERMIT $ <br />PERMIT $ <br />/S <br />TOTAL FEE $ <br />I <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETRASK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBrR FIT <br />PECOPT NO <br />�0 5 <br />USE ZONE <br />LOTAPEA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE Or BLLIGRI <br />PLUMBING <br />T <br />UNITS <br />OCCUPANCY <br />NO Df STORES <br />OCCUPA,.1 LOAD <br />BASEMENT <br />MECHANICAL <br />cnour <br />I <br />OYES ❑ NO <br />ADDITIONAL PLAN CHECK <br />— <br />FIRE SPRINKLER RED D <br />REASON <br />OTHER <br />FIRE ALARM REG'D <br />REASON <br />STALE BUILDING SURCHARGE <br />TYPE Or CONST <br />PLANS APPROVE D BY <br />CITY OF EVERETT <br />PRnI Ic WOPKS <br />---- <br />LOCAL SALES <br />---- <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />DATE <br />