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APPLICATII,N FOR CONSTRUCT rON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />1-1 DEMOLITION I I COMBINATION I I BUILDING 1-1 MECHANICAL I PLUMBING Fl SIGN <br />PROJECT ADDRESS -el2j /l <br />MAIL ADDRESSO (/ CIT _ d ZIP PHONE <br />y vfliP <br />AZ <br />TEN NT <br />MAIL AODRf.SS <br />! I1V <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />UENERAI ONTM R <br />MAILADORESS <br />CITY ZIP <br />PHC'NF <br />STATE LICENSER <br />.Cri'YJ G1� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: fl GAS F1 ELECTRIC Fl <br />CESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PE N AND PI NE NO q R� <br />l .7.4 �"f - <br />GalD <br />Li•Ai6rB�Jfs� <br />I HEREBY CERTIFY THAT I HAVE ^EAD 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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />,;AIUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />_bTHER 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 18.2777 FICWA�NDD 296.200 WAG. <br />X 1 / 4,f� <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK r of 9a`L, <br />_9/e�1 �- /�V <br />�G ,l <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTON LOAN LENDER. AODRESS, TELEPHONE NUMBER <br />SIGNATDRI: 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 FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />T <br />' <br />LAUNDRY TRAY <br />I RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />1 <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FCUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />GAS PIPING <br />' <br />i <br />EXHAUST FAN <br />I <br />I <br />' <br />I <br />I <br />' <br />' <br />I <br />' <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT S <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT k7BAjCK/ <br />PEA" SETBACK / <br />SIDE SETBACKA.A / <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />f1YES M NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />CIZE OF BLOOM <br />I <br />UNITS <br />PLUMBING <br />I <br />OCCUPAOUP NCV NO OF STORIES <br />_ I I <br />OCCUPANT LOAD <br />tq <br />BASEMENT /1� <br />❑YES 1Yi0 <br />MECHANICAL <br />_ <br />ADDITIONAL PLANCHECK <br />I <br />FIRE ALARM REO'D <br />REASON <br />OTHER <br />FIRE SPRINKLER REO'D <br />REASON <br />/a <br />STATE BUILDING SURCHARGE <br />TYPE FCONST <br />- .� <br />PIANS APPROyED BY <br />JlLL` <br />DATE ( Z <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />�T <br />TOTAL <br />Ile d <br />