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APPLICATIN FOR CONSTRUCI".?i N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-BS10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING W ECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:(� I O O FUG op //%/ <br />OWNER HAILADDRESS Cltt ZIP PHONE <br />8y 9 1 5 I2-3S A! Sek#l-e VoL VM. 57F6 —3d'7� <br />AD T:L�NT I/ i-. /) MAIL DRESS CITY ZIP PHONE <br />CITY <br />GENERAL CONTRACTOR MAILADDRESS CITY IIP PHONE STATE LICENSE It <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAILADORESS CItt ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORN <br />_ I/7rj,Q uzr-- <br />HEATING SYSTEM: O'GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />e s� ate <br />T✓IWt.9T, <br />CONTACT PERSON AND PHONE NO <br />L L <br />m,97f*v 4-o <br />5-�L 6 — 3 87 `f <br />I HEREB�YJ CCEERT—IFY- 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 />N'%T. 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X 33 <br />P SE!USE OF BUILOINO <br />\ <br />11 S'l_aC NN�- <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNA U 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 />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK & DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />1 <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />_ <br />I WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />—r- <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />BACKFLOW PFlEVENTERS <br />; <br />GASRANGE <br />; <br />SINK (SERVICE - BAR. ETC.) <br />- <br />GAS PIPING <br />-r- <br />_ <br />EXHAUSTFAN <br />I <br />1 <br />, <br />1 <br />I <br />I <br />, <br />I <br />1 <br />SUB TOTAL $ <br />; <br />SUB TOTAL S <br />; <br />PERMIT $ <br />I <br />PERMIT $ <br />,S I <br />TOTALFEE S <br />' <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑ NO <br />BUILDING. <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />I <br />UNITS <br />PLUMBING <br />I <br />OCCUPANCY <br />NO OF SKRES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />❑YES � NO <br />ADDIIIONAI. PLAN CNFCK <br />I <br />FIRE SPRINKLER REQ'D <br />RFASON <br />OTHER <br />i <br />FIRE ALARM REO'D <br />REASON <br />STALE BUILD"'0 SURCHARGE <br />i <br />TYPE OF G.ONST <br />PLANS A^PROVeD BY <br />CITY OF EVERETT <br />PIIBI IG. WORKS <br />LOCAL SALES <br />- <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />