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iz <br />�jS0sAPPLICIATIVN POOR CONS RUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 0259-8810 4177 <br />Fl DEMOLITION F . COMBINATION n BUILDING Fl MECHANICAL 3er PLUMBING Fl SIGN <br />PROJECT ADDRESS <br />CO lo0 Y.,5w evecc,\ie-en Lkr <br />OWNER _ MAIL ADDRESS CITY ZIP PHONF <br />tun^ea e!Xga,>>> —? /./V l-7a "��e 9� 3� s�� - 3e9-2 <br />ARCHITECTS DEStGINER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILAODRESS CITY ZIP PHONE STATE LICENSE <br />` F CITY ZIP <br />ZIP PHONE STATE LICENSE L <br />Vf r � Y .9`� 2 Jsk I Ni�lPsP�KI 7i�UP <br />CITY ZIP PHONE STATE LICENSE( <br />CONTRACT PRICE OF RK <br />2�DfL <br />HEATING SYSTEM: [...1 GAS Fl ELECTRIC n <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <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 APECIFIED 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 />CONTRACTORS AW 18.27 RCW AND 296.200 WAC./T <br />X 4 < 1—/2 //J <br />PROPOSED OF UILDING� <br />LEGAL DESCRI'TION 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 />SIGNATU DATE <br />CITY BUSINESS LICENSE NO, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -A/HNDLGUNITS -H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS -B.TU. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS - B.T.U. M <br />' <br />_ <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />_ <br />LAUNDRY TRAY <br />) <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DFINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />_ <br />FLOOR WFM*�', <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />I <br />GAS RANGE <br />[A) 2 q <br />GAS PIPING <br />' <br />EXHAUST FAN <br />) <br />I <br />I <br />SUBTOTAL $ <br />; <br />SUB TOTAL $ <br />; <br />_ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $ <br />' <br />_ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />(�-?3 <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />I VALUATION <br />FEE <br />f <br />F1YES Fl NO <br />BUILDING <br />I <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGIT I. <br />UNITS <br />PLUMBING <br />Z2L i <br />T <br />OCo;UPANCY NO OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />i <br />GROUP <br />[]YES I'1 NO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RED <br />REASON <br />OTHER <br />T <br />FIRE SPRINKLER RED <br />REASON <br />I <br />STATE BUILDING SNRCIIARGE <br />i <br />TYPE OF C.ONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PDBUC WORKS <br />LOCAL SALES <br />TAX CODE !S 3105 <br />TOTAL <br />/�� I <br />DATE <br />