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APPLICATI04 FOR CONSTRUCT ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />n DEMOLITION fl COMBINATION n BUILDING Pt -MECHANICAL rl PLUMBING fl SIGN <br />PROJECT ADDRESS��1 <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />PHONE STATE LICENSE <br />CONTRACTPRICEQF WORK <br />iVf`/mil <br />HEATING SYSTEM: Cl GAS fl ELECTRIC rl <br />— <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO, <br />Y <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 COMPLY WITH THE STATE <br />CONTR 18.2j R D .96.20 C. <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 <br />SIGNATUDATE <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 />A/C—A/HNDLG UNITS—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 />' <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />I <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />I <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />I <br />I <br />I <br />' <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />i <br />PERMIT <br />$ <br />I <br />PERMIT 5 <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE S <br />cno nccicc Floc nul V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />oa <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />Fi YES fi NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDG/Tf. <br />UNITS <br />PLUMBING <br />MECHANICAL <br />' <br />i <br />OCCUPANCY NO OFSIORIES <br />OCCUPANTLOAD BASEMENT <br />GROUP <br />' <br />71 YES F1 NO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RED <br />REASON <br />OTHER <br />i <br />I <br />FIRE SPRINKLER RED <br />REASON <br />' <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />TYPE OFC,ONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TOTAL <br />; <br />' <br />TAX CODE IS 3105 <br />DATE <br />