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APPLICATION FOR CONSTRUCT ON PERMIT <br />�* <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98 01 •259-8810 <br />l ^RMMIMATIfLM n wuU. nING MECHANICAL Fl PLUMBING fl SIGN <br />.J VC.mw .w,. I I <br />PROJECT ADDRESS <br />DWNFR MAILADDRESS CITY ZIP PHONE ^ <br />ADDRESS <br />0 <br />5;, <br />CITY <br />ZIP <br />b (-. c,- w 7t_ 1y^^/ � <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WOR <br />HEATING SYSTEM: "AS rl ELECTRIC Fl = <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLV <br />_ <br />CONTACT PERSON AND PHONE NO. - <br />MIICe, <br />5�� <br />�o Sri. <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 />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 PROPERTY )SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />Lp7' 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 />CONTRACTOR;L181.27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE <br />X DATE <br />SIGNATURE <br />CITY BUSINESS LICENSE NO. Q� 1 <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />' <br />A/C —A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />; <br />ORCED AIRS TEMS — B.T. M E.A. <br />------------ T_ <br />LAVATORY (WASH BASIN) <br />I <br />H T PUMP <br />' <br />' <br />SHOWER <br />' <br />UNIT EATERS—B.T. M <br />KITCHEN SINK 8 DISP <br />' <br />I <br />CLOTH DRYERS <br />' <br />DISHWASHER <br />' <br />VENTILATI FAN <br />' <br />LAUNDRY TRAY <br />I <br />ANISE HOE <br />' <br />CLOTHES WASHER <br />I <br />ER HEATER <br />' <br />URINAL <br />WOO TOVE <br />DRINKING FOUNTAIN <br />i <br />METAL FI PLACE (WO BURNING) <br />' <br />FLOOR DRAIN <br />I <br />FIREPLACE SERT (WOOD BURNING) <br />' <br />I <br />BACKFLOW PREVENTERS <br />; <br />GASFIREPLAC <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GA RANGE <br />' <br />GAS P ING <br />EXHAUS N <br />M�!!!SUBTOTAL <br />I <br />I <br />� <br />$ <br />' <br />SUB TOTAL $ <br />) <br />PERMIT <br />S <br />I <br />PERMIT $ <br />' <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />FVM uFrIGC uac vnL.G <br />- <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEES <br />FEE <br />0TAREA <br />VACANT SITE <br />TIYES Tl NO <br />BUILDING <br />tFEERECEIUSEZONE <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />I ' <br />UNITS <br />PLUMBING <br />T <br />MECHANICAL <br />I <br />- <br />OCCUPANCY <br />140 OT STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />f1YE5 fl NO <br />i <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM REOD <br />REASON <br />I <br />OTHER <br />I <br />FIRE SPRINKLER REO'D <br />REASON <br />I <br />' <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKSLOCAL <br />TYPE OF CONST=PIAIIS <br />CITY OF EVERETT <br />SALES <br />TAX CODE IS 3105 <br />TOTAL <br />