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APPLICATIA FOR CONSTRUC&N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING X MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: (o l O CO C YERGWEEa WAY E.yLREiT <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PIIONE STATE LICENSE r <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />L� 1•FG S^aMl�cT.Ea"C. Zu0'aiIppAlptLm QD, Ufor�weoo 9bo)lo 77 -3597 Ca ICKI,*ZIzL'1 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 21P PHONE STATE LICENSE r <br />CONTRACT PRICE OF WORK <br />15DO-0 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SGUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />kgoogo Ep(AlQ5r 4001D <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 GRANTIN3 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE UR 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 />C RACTORS LAW 16.27 RRp\+C'W, AI1YA/,NNDY.2.9,6.200 WRAC.. <br />' (V Y"V�v cJ_IZqlb <br />PROPOSED USE OF BUILDING <br />-bTML) A P <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />' <br />PAIA:EL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LCNDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE 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 EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C— A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />) <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />' <br />EXHAUSTFAN <br />' <br />I <br />' <br />SUB TOTAL S <br />; <br />SUB TOTAL $ <br />; <br />PERMIT S <br />I <br />PERMIT $ <br />' <br />TOTAL FEE S <br />' <br />TOTAL FEE <br />cno nccicc LICE nkil V. <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />T�- <br />DYES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG/TI <br />UN11S <br />PIIIMBING <br />I <br />OCCUPANCY NO 'Jf SICRIES <br />OCCUPANT LOAD BASEMENT <br />MECHANICAL <br />I <br />GROUP <br />_ <br />I <br />❑YES ❑ NO <br />ADD1110NAL PLAN CHECK <br />FIRE SPRINKLER REO'D <br />REASON <br />_.� <br />{ OI HER <br />i <br />FIRE ALARM REO'D <br />REASON <br />STALE BUILDING SIIflCIIARGE <br />TYPE OF f,ONST <br />PLANS APIJIOVED BY <br />CITY OF EVERETT <br />Puanr. WORKS <br />//YI <br />LOCAL SALES <br />-1 B _S / <br />TAX CODE IS 3105 <br />TOTAL <br />Dare <br />t'. S(' 3-11-5C <br />