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APPLICATkoN FOR CONSTRUC I ki ION <br />❑ DEMOLITION <br />ADDRESS <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 0259-8810 <br />❑ COMBINATION <br />530 <br />AAILADDRESS <br />� l�l03 S <br />TAIL ADDRESS <br />VT J, <br />❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />L� <br />CITY 21P PHONE <br />ZIP <br />GENERgL CONTRACTOR MAILgODRESS OHY <br />ZIP PHONE STATE LICENSER <br />c, rH,Gc OF WOOK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PER C'AND PHONE NO. <br />LOT BLOCK <br />CONSTRUCTION LOAN LENDER, ADDRESS .TELEPHONE NUMBER <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIG HE _ 7- 5L.0 <br />GATE <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAL <br />NO. <br />WATER CLOSET (TOILET) <br />TYPE OF FIXTURE OR ITEM FEE <br />' <br />BATHTUB <br />A/C-AMNDLG UNITS - H.P. , <br />; <br />LAVATORY (WASH BASIN) <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />, <br />HEAT PUMP <br />SHOWER <br />KITCHEN SINK & DISP <br />' <br />UNIT HEATERS-B.T.U. M <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />LAUNDR Y TRAY <br />' <br />VENTILATION FAN <br />, <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />, <br />, <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />' <br />FLOOR DRAIN <br />' <br />BACKFLOW PREVENTERS <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />, <br />SINK (SERVICE - BAR, ETC.) <br />; <br />GAS FIREPLACE <br />, <br />' <br />' <br />GASRANGE <br />' <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />, <br />, <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />, <br />PERMIT $ <br />, <br />TOTAL FEE S <br />' <br />TOTAL FEE $1 <br />1 <br />FRONT SETBACK <br />REARPSIZEFOFDG <br />ETBACK <br />PLAN CHECK NUMBER FEE <br />f� <br />RECEIPT NO. <br />USEZONE <br />LOTAT <br />SITE <br />VALUATION <br />FEE <br />YES ❑ NO <br />HEIGHT LIMITATION <br />BUILDING <br />, <br />i <br />NO. OR.I. <br />UNITS <br />PLUMBING <br />I <br />OCCUPANCY NO.OFSTORIES <br />GROUP <br />OCCUENT <br />MECHANICAL <br />, <br />YES p NO <br />FIRE ALARM REO'D <br />REASON <br />ADDITIONAL PLAN CHECK <br />I <br />OTHER <br />/W <br />FIRE SPRINKLER REO'D <br />REASON <br />STATE BUILDI G SURCHARGE <br />i <br />TYPE OF CONS.. <br />PLANS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />1 <br />JM LOCAL SALES <br />TOTAL <br />-" <br />DATE TAX CODE IS 3105 <br />