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APPLICATI00 FOR CONSTRUCTi011 PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 : 259.8810 <br />❑ DEMOLITION Fl COMBINATION fl BUILDING n IUPrIJAFu(rAL <br />PROJECT ADDRESS <br />OWNER MAIL ADDRESS <br />CITY ZIP PHONF <br />:36 r49tr-r llf -V00W 5E4ntO 19/2/ 9LY--7i7s <br />---- _-- <br />.......---..l.... wT <br />ZIP <br />PHONE <br />GENERALCONTRACTOR <br />F OA L SIG}✓ l0/16 <br />MAILADDRESS CITY <br />12SS wFf�tAA�A� At' SC�tjyl e <br />ZIP <br />94/0'l <br />PHONE <br />STATii LICENSE. <br />'"Z-"ov <br />10-;7695f-f.S�Z <br />MEOHANICALCONTRACTOR <br />MAILADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />PLUMBING CONTRACTOR <br />MAILADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />CONTRACT PRICE OF WORK <br />1 N `00 <br />-- <br />HEATING SYSTEI:: Ll GAS n ELECTRIC n <br />DESCRIBE WORK AND SOU4k FOOTACIEINVOLVED <br />LST,ryLL Cl MOON A7✓ <br />CONTACT PERSON AND PHONE' <br />1 Sp &wm t4a st0J— LTL4(,o 7xe&-r" <br />M'✓0 0416 S.'FT Ot iwpj)(• /"w 61q*4virl- L-fA.$ <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 />WOHK 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 />CON TRAC RS LAW 6.27 RCW AND 296.200 WAC. <br />l <br />X 6-74-fx <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 />SIGNATU 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 />A/C -A/HNDLGUNITS -H.P. <br />I <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 />i <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />I <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />; <br />SINK (SERVICE -BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />; <br />I <br />, <br />I <br />1 <br />, <br />SUBTOTAL S <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />�RSET� <br />�l <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE O <br />RECEIPT NO. <br />/� <br />G N/�ACIy ,� <br />USE ZONE. f <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />Cl 1` <br />BUILDING <br />Tl YES 17 NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGITI. <br />PLUMBING <br />' <br />UNITS <br />OCCUPANCY NO OF 510RIES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />I <br />MECHANICAL <br />(IYES n NO <br />ADDITIONAL PLAN CHECK <br />I <br />I <br />FIRE ALARM RED <br />REASON <br />OTHER <br />i <br />' <br />FIRE SPRINKLER RLG'O <br />REASON <br />STATE BUILDING SIJRC14ARGE <br />1 <br />1� <br />TYPE OF CONST <br />PLANSAF P_OVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />iryv <br />LOCAL SALES <br />TAX CODE IS <br />TOTAL <br />DATE •5 <br />3105 <br />F,1 <br />