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I <br />APPLICATIL A FOR CONSTRUCT .dN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING B-MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />OWNER <br />Ti <br />MAIL ADDRESS <br />7 <br />CITY j,P PHONE <br />PHONE <br />ARCHITECT OR DESIGNER MAII ADDRESS CITY /IP PNONF <br />GENERAL CONTRACTOR MAIL ADORE SS CITY ;Ir PHONE STATE I ICE NSE• ,OpTiP/CF iF <br />PA-r,Plo -, F/nE -pele) i/c.✓ e4c�,A 44 Tf A✓E t> E >f1COMA, WI) 9,(4?4 q2G-11S0 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY TIP PHONE STATE LICENSE, <br />MAILADDRESS <br />CITY <br />PHONE STATELICENSE <br />CONTRACT RICE OF WORK <br />iy . D D <br />HEATING SYSTEM: Cl GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SO ARE FOOTAGE INVOLVED <br />Loc >e' Q[ A AC LE2 <br />)1'A45 <br />CONTACT PERSON AND PHONE NO <br />&W 9Z,1 -12 9 0 <br />oR LL <br />6f /CE <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 />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 />CON7TO11S LAW 18927 RC/W/' AND 296.200 WAC. <br />X <br />SIGNATURE Z 4— ^ / DAT <br />CTL <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY[SHOW'N BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />CITY BUSINE SS L ICENSE NO <br />PLUMBING _ <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—AMNDLG UNITS <br />' <br />_BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />UNIT HEATERS <br />' <br />KITCHEN SINK 6 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE. —BAR, ETC.) <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />iEIJEF- <br />LG tC <br />I <br />I <br />I <br />' <br />� <br />T <br />SUB TOTAL S <br />SUB TOTAL $ <br />) <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S <br />_T <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />rCIF <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SIIE <br />FEES <br />VALUATION <br />FEE <br />DDIL ❑tNG <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />^.IZE OF BLDGITI <br />UNITS <br />PLUMDING <br />OCCUPANTLOAU <br />BASEMENT <br />MFOInNICAI-- <br />�— <br />OCCUPANCY BCI ,TIES <br />GROUP <br />❑YEs ❑ NO <br />ADDIIIONAI. PI AN CItf CK <br />— <br />FIRE SPRINKLER REGO <br />REASON <br />OlRr.l <br />///J i <br />�] t <br />FIRE ALARM REO'D <br />REASON <br />STATE D:IIL NO SRECHARGE <br />TYPE Or,;ONST <br />PIANSAPPROVED RV <br />CITY OF EVERETT <br />rUBllr.wOPxq <br />JM <br />LOCAL SALES <br />--- <br />TAX CODE IS 3105 <br />TOTAL <br />���_ <br />