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APPLICATIA FOR CONSTRUC&N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 4wf r <br />❑ DEMOLITION Fl COMBINATION Fl BUILDING F 1 MECHANICAL Fl PLUMBING Fl SIGN <br />PROJECT ADDRESS <br />ZIP / PHONE <br />DESIGNER MAIL ADDRESS CITY <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE, <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: n GAS Fl ELECTRIC n <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <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 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 />CON ACTORS LAW 18.27 RRCC"W AND 296.200 WAC. <br />t../.�� / / Z 7/ / <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 LOAN LENDER. ADDRESS. TELEPHONE NUMBER,%La�]+. <br />NATURE 0 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 />WATER CLOSET (TOILET) <br />' <br />A/C -A/HNDLGUNITS -H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />r <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />) <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />r <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />r <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />r <br />GAS RANGE <br />' <br />GAS PIPING <br />' <br />i <br />EXHAUST FAN <br />I <br />r <br />SUB TOTAL S <br />; <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTARFA <br />VACANT SITE <br />FEES <br />I VALUATION <br />FEE <br />T1YES r! NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF RIGOR I. <br />i <br />UNITS <br />PLUMBING <br />i <br />OCCUPANCY <br />NO OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />GROUP <br />fI YES fl NO <br />ADDITIONAL PLAN CHECK <br />r <br />i <br />FIRE ALARM RED <br />REASON <br />OTHER <br />r <br />FIRE SPRINKLER REO'D <br />REASON <br />i <br />STATE BUILDING SURCHARGE <br />i <br />TYPE OF C,ONST <br />PLANS APPROVED BY <br />CITY OF EVERETTPUBLIC <br />WORKS <br />I <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />1 TOTAL <br />