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APPLICATItoN FOR CONSTRUC'Ill .ON PERMIT <br />CITY OF EVERETT E BUILDING DIVISION <br />3200 CEDAR STREET E EVERETT, WA 98201 E 259-8810 <br />I DEMOLITION I I COMBINATION I I BUILDING MECHANICAL (I PLUMBING f I SIGN <br />PROJECT ADDRESS T v7 / y 20 <br />I . %LY EIT ro n.c i w 'A7_I 1'S. :1 -A :r hR/—/JN <br />n MAILADDIESS CITY m• r,rorve <br />Q � rQcc) 3�3 19 �Qt-t C� cIs L� n� �ci . rtt sty 03 <br />1 MAII. ADDRESS CITY 71P PUONF <br />ARCIIITECTORDESIGNER MAILAODRESS ITY nr I•nuNv <br />\N R=LL CONTRACTOR n _ MAIL=[1 ^55 Inn 1 _i L-j I Y - ^` `/71P _'-`{((/\QP14IE SIS_1�76ALICENS rQlrc,ZL <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICEnx9 •/ <br />7 <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY ZIP <br />PHONE STATE LICENSEE <br />CONT F TV WORK <br />r7 <br />HEATING SYSTEM: GAS f l ELECTRIC n <br />SCRIBE A �OUARE FOOTAGE OLVED <br />. <br />C NTACT PERSON ANO P110NE NO <br />I.'�-9106 <br />6 <br />lour g . <br />1 _3 <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 />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <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 16.217\�Rr\C�W\ AND 296._20IA00 WAC. <br />PARCEL TAX I.D. NUMBER <br />�1 <br />X A .\, \C}tl A.\lam ' /A* is--g I(� <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNAT RE DATE <br />CITY BUSINESS LICENSE NO <br />KUMOM <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />T <br />WATER CLOSET (TOILET) <br />I <br />A/C — A/HNDLG UNITS — H P. <br />' <br />BATHTUB <br />i <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />) <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />' <br />VENTILATION FAN <br />— ! <br />LAUNDRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />I <br />WO,TER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />) <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLCW PREVENTERS <br />i <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />OAS RANGE <br />' <br />' <br />GAS PIPING <br />' <br />EXHAUST FAN <br />_ <br />' <br />I <br />, <br />T <br />' <br />, <br />SUB TOTAL <br />E <br />SUB TOTAL E <br />O ' <br />PERMIT <br />E <br />I <br />PERMIT E <br />TOTAL FEE <br />E <br />TOTALFEE E <br />13S ' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USEZONE <br />LOTAnEA <br />HEIGHT UMITAT,ON <br />NO OF DWELLING <br />UNITS <br />OCCUPANCY I NO OF STORIES I OCCUPANT LOAD <br />REO'D <br />OF CONST PLANS APPROVED BY <br />DATE <br />SIDE SETBACK PI AN CHECK <br />VACANT SITE <br />I I NO <br />)YES I <br />BUILDING <br />BIZE OF BLDGIT I <br />PLUMBING <br />MECHANICAL <br />BASEMENT <br />TIYES II NO <br />— <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />FEE RECEIPT NO. <br />• <br />