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APPLICATItod FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8610 <br />❑ DEMOLITION n COMBINATION fl BUILDING Fl MECHANICAL I , PLUMBING f 1 SIGN <br />PROJECT ADDRESS 5-30 S ((,/ /, L <br />/ f <br />OWNER MAILADDRESS CITY ZIP (•(l PHONE <br />W P Seo,5 )f rx oc 160? 2)d '� SW iWoai j4.A,Terr 9Jo L13 (A, GOS 2.2 -.4"33 <br />TENANT " - MAILADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />rCONTRACTOR <br />11 el•1DfO15OFh� <br />ZIP�PHONE <br />� <br />STATE <br />MECHANICAL CON TRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />Pj'tjI4rCl Lti ,•A. T 2 /q I4" tEz A94zG'i. ('D.N�Ps"t 'w1' <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: Cl GAS Cl ELECTRIC n <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Oo0 r + <br />CONTACT PERSON AND PHONE NO. <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 />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 />CONTTRRAAjCn�TORS LAW 18.27 RCW AND 296.200 WAC. 7 C <br />"' -4 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAM LENDER, ADDRESS, TELEPHONE NUMBER <br />NATURE DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />( <br />WATER CLOSET (TOILET) <br />I <br />A/C-A/HNDLGUNITS -H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />' <br />VENTILATION FAN <br />1 <br />LAUNDRY TRAY <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />1 <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />; <br />SINK (SERVICE - BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />i <br />1 <br />1 <br />1 <br />1 <br />I <br />I <br />I <br />I <br />SUB TOTAL S <br />; <br />SUB TOTAL $ <br />PERMIT S <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />1 <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH C MBE <br />FEE <br />RECEIPT NO. <br />i <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />TTYES Tl NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDG/f I. <br />PLUMBING <br />I <br />UNITS <br />OCCUPANCY NO 0151011IES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />I <br />MECHANICAL <br />LT YES n NO <br />ADDITIONAL PLAN CHECK <br />i <br />FIRE ALARM RED <br />REASON <br />OTHER <br />FIRE SPRINKLER RED <br />REASON <br />STATE BUILDING SURCHARGE <br />I <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITYOFEVERETT <br />PURLICWORKS <br />I <br />LOCAL SALES <br />— <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />