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APPLICATIO►_ FOR CONSTRUCTLoN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CLDAR STREET • EXIERE'iT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING/ ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:_ <br />OWNER MAILADDRESS CITY ZIP PHONE <br />S4, sr�:Y �03 S�,.t� 57L Se4-{le. Qlk Y3/0S4 <br />TEE rNT MrAIL ADDRESS ✓ CITY 71P / PHONE <br />l"Tl(�c(Gb4jfC',t- pllr ' z ZSL� .��%f'/e &;f 98/2/ <206) 7Z8�-7o7o <br />A IT�1 ECTORDESIG R MAILL/ ADDRESS CITY ZIP ,((,/ PHONE <br />i l Gr�heiSNr/J 202i`" FF,;L uG �2 SPQ/// (V YSiz�C2-Q �P/-2FV <br />GE CONTRACTOR Lh1�AIL DRESS / CITY Ilf PIIONE STATE LICENSE F <br />ch.c/ivn /155oc;c�'%�t D / o q% ,,, LcJ/9- 98oS�6CZe61 77�-3�Z/�nsfl`pNA <br />M H NI <br />EC --co <br />A CALCONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PfLONE <br />STATE LICENSE) <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PRICE OF WORK <br />3, Gob <br />HEATING SYSTEM: 'RdAS ❑ ELECTRIC ❑ <br />DESCRIBE Ljgf¢( AND §OUARE FOOTAGE INVOLVED <br />C Cc, - �.k/ <br />.L <br />f ex, <br />CONTACT PE O AND ONE NO. <br />CLY's '65�a�� a / k7 ' 7a:- <br />o' Ice <br />2,06)72 -7o 70 <br />lbrq o� f Oue.� QvU <br />CONa er �- <br />1 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 - , E 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 REGULFTING 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 IOW 6.27 D 296.200 WAC. <br />/�/ <br />PROPOSED Uportl 1IL61NG <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSI HUC;UON L07 LENDFjR. ADDRESS. TELEPHONE NUMBER <br />o eN er <br />SIGNATURE 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/HNDLG G:JITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />I <br />RANGEHOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />v <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />, <br />GAS PIPING <br />, <br />EXHAUSTFAN <br />, <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />; <br />PERMIT S <br />, <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />v` 2 <br />FEF� ^ /J/_ <br />LVALLUATIION!/ <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑ NO <br />FEES <br />FEE <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF BLDGR.I <br />��'� •�+I. <br />Y 11 <br />PLUMBING <br />, <br />T <br />OCCUPANCY <br />GRWP <br />1 NO OF STONES <br />OCCUPANT LOAD BASEMENT <br />OYES A§N0 <br />MECHANICAL <br />ADDITIONAL PLAN CIIF.CN <br />, <br />FIRE SPRIg1yK1 L�EjR9REO'D <br />REASON <br />07HEFI <br />I <br />FIRE ALARM REGO <br />4,YG] <br />REASON <br />909T <br />STATE BUILDING SURCHARGE <br />TYPE OF f.ONST <br />'� v <br />PLANS APPROVED BY <br />AIM <br />DATE P <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PIIBI If. WORKS <br />TOTAL <br />--1— <br />I <br />D <br />