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APPLICATIt.A FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9d201 • 259-8810 <br />� NG fl SIGN <br />❑ DEMOLITION ❑ COMFSINATION f7 BUILDING 6�G MECHANICAL _ PLUMBI <br />PROJECT ADDRESS I' ^q � 1 I � <br />SI � S(.l� LU e p E t-1- /"l I o��/ <br />cm <br />� <br />TENANT MAIL�DDbE55 �� CP`! // ZIP rnurve�Z�✓ J <br />[/ <br />PFCHITECTORDESIGNER MAILADDRE55 Cltt ZIP PHONEO/j�7, /)rJ� Z7 � <br />Q (�Cl C/ G C� <br />DE IBE Y70RP ANO SOUARE FOOTAGE 1^ � C VOLVED(� <br />( . Y;�2;,0� <br />PROPOSE� USE OF BUIL�ING <br />LEG�L DESCRIPTION OF PROPEf7TY (SHOWN BELOW OF7 ATTACH TWO <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBER <br />CONSTFIUC7�ON LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />NO. TYPE OF FIXTURE OR ITEM <br />rj" WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWEA <br />KITCHEIJ SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />BACXFIOW PREVENTERS <br />1 SINK ISERVICE — BAR, ETC.) <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE <br />FOR OFFICE USE ONLY: <br />FROM SETBACN AEAH SETBACK SIOE SETBACN <br />USEZONE <br />HEIGHT IIMITATION <br />OCCUPANCY N0.( <br />GiiOUP <br />FIRE All�NM REO'0 <br />LOTAREA <br />NO.OFOWELLING <br />UNITS <br />VACANTSI�E <br />OYES ❑ NO <br />SIZE OF BLOGR.I. <br />HEATING SYSTEM: 6d GAS ❑ ELECTRIC ❑ <br />CONTACi PEFSON ANU PHONE NQ � <br />M• 1_ _ f"'. 11• 4�'1—a4i..-. <br />I HEREBY CERTIFY THAT I HAVE R�AD AND EXAMINE�� THIS <br />APPLICATION AN� KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PRO`JISIONS OF LAWS AND ORDINAP:CES GOVERNING TI-IIS 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 OFl 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 />CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br />X`-rvl�o �I .�,�.�� � ar�99s- <br />, �. <br />SIGNAiURE OATE <br />CITV BUSINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —NHNDLG UNITS — H.P. ' <br />FORCED AIR SYSTEMS — B.T.U. M E.A. i <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 RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT 3 <br />TOTALFEE 5 <br />PLAN CHECN NUMO[R FEE I RECEIPT NO. <br />DUILDING <br />PLUMBING <br />�SEMENT MECHANICAL <br />❑YES ❑ NO <br />POOITIONAL PLl�N CHECK <br />OTHER <br />STATE BUILOING SURLHMGE <br />CITY OF EVERETT P�BLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />