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APPLICATA FOR CONSTRUC*ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257.8810 <br />❑ DEMOLITION ❑ p� COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ADDRESS <br />PHONE <br />FZt .�.rT <br />CONTFILCT PRICE OF IMORK <br />� <br />HEATING SYSTEM: AGAS ❑ELECTRIC ❑ <br />DESCRBEVIORK ANO ARE FOOTAGE BNOVED <br />CONTACT PERSON(�+D PIgNE NO. <br />��c.tl✓ay,4o S l6156 Q/_S i <br />Nora/1-yeI c�/I.1,tT,�2f.94YFrL�rlcrnsM. <br />I HEREBY CERTIFY THAT 1 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 />CONTR�LA T0.27 RCW AND 296.200 WAC. <br />NM DATE <br />PROPOSEDUSEOFBURDING <br />LE DEWAPtKNl OF PROPERtYI NDVM BELOW oR AD rwo IEsI <br />LOT Lz�z_BLOCK OF , F <br />K rcE va #'(u/2 <br />PARCEL TAX 10. NUMBER <br />023 29s - <br />CONSTRUCTION LOAN LEADER ADDRESSi LEPIN)NENUUBER <br />GIY BUSINESS UCETISE NO.. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPC OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET)I <br />AIC—AMNDLG UNITS <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS <br />LAVATORY IWASH BASIN) <br />HEAT PUMP <br />SHOWER <br />j <br />UNIT HEATERS <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />! <br />URINAL <br />j <br />METAL FIREPLACE (WOOD BURNING) <br />j <br />DRINKING FOUNTAIN <br />j <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />! <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />1 <br />SUBTOTAL <br />S <br />j <br />SUBTOTAL $ <br />i <br />PERMIT <br />SI <br />j <br />PERMIT S <br />TOTALFEE <br />SI <br />i <br />TOTAL FEE S <br />i <br />FOR OFFICE USE ONLY: COO F1 `�,, <br />FROM SETBA�f- <br />PEN SETBAC1t <br />1 UU F <br />SIDE SEi'ACN F <br />PLAN CNECX USER <br />fE ��� �/ <br />RECEIPT NO. <br />USE T�gNE' <br />LOTAREA <br />VACANTSITE <br />OYES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />6 a7a <br />NEIGHTLWITANOR <br />NO OF BWELLING <br />BUT OF BLBL <br />W <br />30 <br />PLUMBING <br />CCCUPN Y NO OF STORES <br />/s- <br />OCCUPANT LOAD <br />' <br />GA ENT <br />OYE6 NO <br />MECHANICAL <br />AGOAION4PLNICHEGX <br />O <br />FIRE 6PRINKLER REDD <br />\ LT'S <br />REASON <br />OTHER <br />FIRER MPEOD <br />�ES <br />REASON <br />-'i ? <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />1 , <br />PVNSAFPROYEOGY <br />Q 1 <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 I <br />IPUSUCMAKS <br />TOTAL <br />