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APPLICATIOQ FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 A257.8810 <br />u ULMULITION ❑ COMBINATION ❑ BUILDING O MECHANICAL PLUMBING ❑ SIGN <br />PROJECT AD3RESS,,, 15 <br />OWNER MAILADDgE55 Lltt jp pKME <br />GENERAL CONTRACTOR MAB.ADORESS CITY ZP N"E STALE OCEN$EF <br />CONTRACT PRICE OF WORK <br />- <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FW )AGE IWOLYEB <br />CONTACT PEPSON AND PHONE NJ. <br />I IIEREUY 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 1 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 />NLAWIB, RCWAND296.200WAC. <br />;iNA&WRC <br />PROPOSED USE OF BUILDING <br />LEGµ OESCPIPIgN OF PROPERTY (SNONN BELOWOR ATTACH TWO COPIES) <br />LOT BLOCK __OF <br />PARCEL TAX I D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />DATE <br />CITY BUSINESS LICENSE W. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />VIAfER CLOSET (TOILET) <br />ABC—A/HNDLG UNITS <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS <br />I <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />— <br />SHOWER <br />UNIT HEATERS <br />) <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />i <br />-SW <br />DISHWASHER <br />RANGE HOOD <br />f1111111. <br />LAUNDRY TRAY <br />WATER NEATER <br />`+fir <br />CLOTHES WASHER <br />WOOD STOVE <br />�— <br />"�" <br />URINAL <br />METAL FIREPLACE (WOOD BURNINGI <br />I <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK(SERVICE —BAR, ETC.) <br />) <br />GAS PIPING <br />— <br />EXHAUSTFAN <br />I <br />i <br />— <br />t <br />SUBTOTAL $ <br />I <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE E <br />TOTALFEE S <br />FOR UFHICE USE UNLY: X re-,,-, O_rn ,-T <br />FRONT SETBACK <br />FEAR SETBACK <br />SIDE SETBACK <br />vv <br />PLVI CHECK MIMBEP FEE <br />RECEIPT NO. <br />USE LONE <br />LOT AREA <br />VACANTSITE <br />DYES DNO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />HEIGHTLIMITATION <br />NOIT$OF DWELLING <br />UN <br />SIZE OF BLC041. <br />PLUMBING <br />OCCUP"zY <br />GROUP <br />I NO OF$TDAES <br />OCCUPANT LOAD <br />BASEMENT <br />DYES ❑NO <br />MECHANIC:µ <br />FIRE SPRINKLER ROD <br />REASON <br />ADRIIKKULPUUi CHECK <br />OTHER <br />FIRE ALARM RED <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONSr <br />rwISAPPPavco BY <br />DALE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICwORKS <br />TOTAL <br />