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APPLICATICod FOR CONSTRUCT iON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />(l DEMOLITION �l COMBINATION rl BUILDING ] MECHANICAL r l PLUMBING SIGN <br />[PR:0]CT ADDRESS <br />�Im <br />`OWNER (T WA• VY/% <br />�r(i Y n w MpIiADDRE55 <br />A. i _ CITY ZIP nunuo <br />MAIL <br />MAIL <br />0 CAME W AND SQUARE FOOTAGEINVOLVED <br />� <br />neon COPS On builAi �ue�4 1 <br />PROP BED USE OF BUILDI G <br />om r DI <br />LEGAL OEBCRIPTION OFP OPERTY (SHOWIl BELOW <br />LOT BLOCK nr <br />CONSTRUCTION LOAN LENDER. <br />TYPE OF <br />CLOSETI <br />KITCHEN SINK 8 DISP <br />CLOTHES <br />FLOOR <br />FOR OFFICE USE ONLY. <br />TELEPHONE NUMBER <br />iE OR ITEM7--F FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />CITY <br />I <br />7fP <br />PHONE STATELICENSE• <br />ZIP <br />ZIP PHONE STATELICENSE• <br />HEATING SYSTEM: I I GAS !-7 ELECTRIC R <br />CgNy CT PEP,�oN AND PNONE ND. <br />Vf1n (`n�ll� ��i_vvz� <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 />PEIIFORMANCE 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 />CONTRA TORS LAW 18, 7TIiCW A D 296.200 WAC. <br />X <br />SIGNATURE DATE <br />'ITV BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C -A/HNDLG UNITS -H.P. , <br />FORCED AIR SYSTEMS - E.A. <br />HEAT PUMP <br />UNIT HEATERS - B.T.U. M , <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD , <br />WATER HEATER �- <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) , <br />GAS FIREPLACE , <br />GAS RANGE <br />GAS PIPING , <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />LHUNT SETBACK <br />USE ZONE <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />RYES fl NO <br />PLAN CHECK NIIMOFR�/j7/T/ <br />` ' / ✓ <br />FEES <br />FEE %yq � <br />VALUATION <br />RECEIPT NO. <br />FEE <br />BUILDING <br />a yvoy <br />�QQ <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />UNITS <br />SIZE OF BLDG/TI <br />PLUMBING <br />OCCUPANCY rN0001 STORIES <br />GROUP <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />I <br />AYES t'1 NO <br />I <br />FIRE ALARM RED <br />REASON <br />ADDITIONAL PLAN CHECK <br />_ <br />OTHER <br />FIRE SPRINKLER RED <br />REn$ON <br />STATE BUILDING SURCHARGE <br />PUBur, WORKS <br />I <br />TYPE OF rONST <br />PLAN APPROVED BY rill <br />CITY OF EVERETT <br />LOCAL SALES <br />TOTAL <br />DATL"� 1 . �-� _ ` �, TAX CODE IS 3105 <br />