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APPLICATIGA FOR CONSTRUCTrON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />I I DEMOLITION I I COMBINATION V BUILDING [I MECHANICAL ❑ PLUMBING ❑ SIGN <br />IPROJECTADDRESS /919 ze�jergreen (�QY,✓Nfe II I <br />ROWNER 1n MAILADDRESS CITY JJ /�ZIIPP h PHONE <br />�JVWIC� ii�11QN•AILAODR/8� r4,II ��JeryQ11 79po� PI/ONE a-0-2 <br />TENANT ZIP <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />PLUMBINC CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSER <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DESCRI6E WORK AND SQUARE FOOTAGE INVOLVED <br />oo s <br />CONTACT PERSON AND PHONE NO. <br />La sen - <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 />CONTRAC RS LAWC I�B27 RCW AND 296.200 W/ACo. <br />h')-ems 9y SIGNATURE DATE <br />PROPOSED USE OF BUILDING <br />.2 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK oF._!d eV 1 5 <br />PARCEL TAX I.D. NUMBER <br />39 -oo oa <br />CONSTRUCTOR LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—AIHNDLG UNITS —H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />I <br />' <br />I <br />; <br />SUBTOTAL S <br />; <br />SUB TOTAL $ <br />; <br />PERMIT S <br />I <br />PERMIT S <br />' <br />TOTAL FEE S <br />' <br />TOTAL <br />PnP FTFFICF IISF nN1 Y- <br />FRONT SETBACK <br />REM SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />a <br />USEZONE <br />LOTMEA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE . <br />BUILDING <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO. OF DWELUNG <br />SIZE OF OLDGfLI. <br />' <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />GROUP <br />I NO. OF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />I <br />I <br />OYES ❑ NO <br />FIRE ALARM RED <br />REASON <br />OTHER <br />FIRE SPRINKLER REDD <br />REASON <br />STATE BUILDING SURCHARGE <br />- I <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />1 TOTAL <br />