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APPLICATAN FOR CONSTR C AONPERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS <br />-%7AA]'c A :w75 - /L/Ca Si czEe9[TA(/�� Glee r.T/fif.-i A14 Tops N12 355.5NNe/ _ <br />TENANT MAILAODRESS LRY / IIP 1H 1E <br />COMMCT PACE OF WORK 000v <br />HEATING SYSTEM: ❑GAS El ELECTRIC ❑ <br />p RISE KOi1KANDSOUARE fCOTAGE INVOLVED <br />G L Ci <br />CONTACT PERSON AND PHONE NO. <br />I <br />j` <br />STpyFI-lrAVT - <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 />APPLICATIO14 IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW I8.27, RCW AND 296.200 WAC. /�}/� <br />X ����" �-06 <br />PRO OSED USE OF BUILpmD <br />f7A1 IF <br />LEGAL. DESCRIPTION W PROPERTY ISIGWTI BELOW ORATACH RG COPIES) <br />UOr BLOCK -oF_ <br />PARCEL TAX 10 NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />S NATURE DATE <br />CITY BUSINESS LGENSE NO. <br />PLUMBING <br />MECHANICAL <br />YO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C-NHNDLG UNITS <br />_ <br />BATHTUB <br />! <br />FORCED AIR SYSTEMS _ <br />LAVATORY (WASH BASIN) <br />i <br />HEAT PUMP <br />i <br />SHOWER <br />j <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />i <br />WOOD STOVE <br />! <br />URINAL <br />! <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIF,.PLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE - BAR. ETC) <br />! <br />GAS PIPING <br />I <br />EXHAUSTFAN <br />i <br />t <br />i <br />SUBTOTAL S <br />i <br />S'JB TOTAL S <br />PERMIT S <br />i <br />PERMIT S <br />TOTALFEE S <br />i <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: (7, An r, SA - AM <br />FR@ITSETBACX <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHECK NDVBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACMITSITE <br />OYES 0 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />HEGHTLINITAT N1 <br />NO O'DM1wG <br />UNITS <br />SIZEDFBLWrt.I <br />PLUMBING <br />U pNICI NODE STORES <br />OCCUPANT LOAD <br />BASEMENT <br />DYES ❑NO <br />MECHANAAL <br />ADDITIONAL PLAN CHECK <br />FIRE SPRINKLES RED <br />REASON <br />OTHER <br />FWEALARAI <br />REASON <br />STGE BWLDING SURCHARGE <br />T (RE OF LOBST. <br />PLANS APPROVE By <br />DAM <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3106 <br />MIBLG YronKS <br />TOTAL <br />