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APPLICATIk. A FOR CONSTRUCI ,ON PERMIT <br />CITY OF RE • BUILDING DIVISION <br />3200 CEDAR STREEETT A EVERETT, WA 98201 • 159-8810 O <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ccc <br />oW+(En MAILAOd1ESS CITY JIP PFONr <br />T�TENANT All AOURFSS CITY 71P PIgHE <br />ARCHITECTORDESIGNFII MAIL ADDRESS GIIY JIP PITON( <br />fF)1(E TRACT��`�MAII A4-7n 55 1 CITY n /� I � O 1910� 51AIL IICf NSE <br />ta <br />l17YQ7_r1.. Y / <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY JIP PHONE STATF LICENSE <br />PLUMBWGCONIRACTOR MAIL ADORE SS CITY III; PHONE STATE LICENSE <br />COLITRI:T PRICE OF WORK <br />HEATING SYS-fEM: ❑ GAS ❑ ELECTRIC n <br />DES�RIBF NgRK ANO WME EOOIME INVOLVED <br />CINIIACI PEDSONANOPIK)NL NO <br />I HEREBY CEF IFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCI=S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WEILTHER SPECIFIED HEREIN OR <br />NOT. THE 09ANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHON:rt 10 VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF :ONSTRUCTION. 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 iB 27 RCW AND 296.200 WAC. / <br />X l�-(,�� Z ����� / ! a <br />V� <br />PPOPOSEUUSE OF BUILDING <br />5 <br />G= <br />1 <br />_ <br />LEGALDESCMPFIONOFPRDKFIIYISHO:•CIBLLpWIX1AilACHTW000PIE5! <br />LOT BLOCK _Or <br />PARCEL TAT 10 NUMBER <br />CONSiRUCiKM/lOAN LENDFR, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMSIN0 <br />MF.CHAN_ IC OL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A`HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS___ <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />_ <br />METAL FIREPLACE (WOOD DUNNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />I <br />I <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />' <br />SINK (SERVICE —BAR, ETC.) <br />GAS PIPING <br />�— <br />EXHAUST FAN <br />_ <br />—:— <br />SUBTOTAL f <br />PERMIT f <br />ff <br />PERMIT f <br />�— <br />TOTAL FEE S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REA"SFTBWK <br />SIDE SETBACK <br />PLAN CIIECK NUURfR <br />FIT <br />RLCFIPi NO <br />USE ZONE <br />IOYAnEA <br />vrANI SITE <br />FEES <br />VALUATION <br />FEE <br />BINDING <br />- —'— <br />G� ) <br />2 I — <br />- <br />Crrs L] No <br />NEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE Or RI OGRI <br />IIN115 <br />PI IIMLIIrIfi <br />—�- <br />p^COU�ANCY <br />NO (N $IMYlS <br />OCLNPANI IOAU <br />BASF 4ENf <br />MFCNANIUI <br />❑vF5 D NO <br />__ <br />_.--__._ .-- <br />_.—__ <br />AINNRONM PLrNCIIrCK <br />FIRESPRINKLERREGD <br />RF ASON <br />OIIIF iI <br />_ <br />RF AS(NI <br />i <br />FIRE ALAnM REO'D <br />STAIF Run DPIO SIInGIIAnGF <br />�Lf <br />TYPE WCONSr <br />PI nNS APPnnvr P BY <br />CITY OF EVER ETT <br />runny YttNIKC <br />LOCAL SALES <br />-)— <br />TOTAL <br />DAIS <br />TAX CODE IS: 5 <br />A <br />