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110-1 <br />APPLICATIO.,d FOR CONSTRUCTWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: <br />ADDRESS <br />OWNER MAIL �u "• <br />7 ADREG <br />TENANT MAIL ADADDRESSCITY 71P PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 71P PHONE n W <br />GE��A'CONIRACJOIi.r�r�lllLiDDR �I.7�GF� �G. -CITY i 3�j�( 7���ZI ���/� Z PHONE <br />q���IE IICENS3 <br />CITY ZIP PHONE STATE LICENSE T <br />PLUMBING CONTRACTOR MAILADDRESS City ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORIfa <br />HEATING !;YSTEM: ❑ GAS ❑ ELECTR!C ❑ <br />AV <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTA T PERSC " AND PHONE NO <br />/- L/ - 3 <br />C!v ct� <br />IG / 3 .�• <br />� <br />7 N <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />c- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PITY (SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK of <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 />CONTRACTORS LAW 1B.27 RC AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SI N TU E DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—AMNDLG UNITS <br />' <br />_ <br />FORCED AIR SYSTEMS <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />' <br />SHOWER <br />UNIT HEATERS <br />I <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />i <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />, <br />WATER HEATER <br />) <br />CLOTHES WASHER <br />I <br />WOOD STOVEURINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />' <br />EXHAUST FAN <br />I <br />1 <br />SUB TOTAL $ <br />I <br />; <br />SUB TOTAL E <br />' <br />PERMIT 5 <br />I <br />PERMIT E <br />TOTALFEE E <br />TOTAL FEE E <br />FOR UFFII:t Ubt UnII-T: <br />REf.EIPT NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEF <br />r <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ElNO <br />BUILDING <br />I <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG/TI <br />UNITS <br />PLUMBING <br />MECHANICAL <br />I <br />OCCUPANCY <br />NO OF SIORIES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />DYES D NO <br />' <br />ADOIIIONAI. PLAN CHECK <br />I _ <br />FIRE SPRINKLER REGO <br />REASON <br />OUTER <br />FIREALARMREO'0 <br />REASON <br />STATE BUILDING SIIRCIIAOGE <br />PHBIIF, WORK5 <br />TYPE OF CONST <br />BYT <br />ITY OF EVERETT <br />7ANAPPROVED <br />LOCAL SALES <br />AXCODE IS 3105 <br />TOTAL <br />