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APPLICATION FOR CONSTRUCT mON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING <br />PROJECT ADDRESS <br />O 6-I.✓. <br />I "'Y I I / ZIP <br />MECHANICAL ❑ PLUMBING ❑ SIGN <br />m <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE STATE LICENSE 0 <br />MECHANICAL CONTRACTOR MAILADDRESS CITY <br />ZIP NONE %; 6- /,YJOSTATE LICENSE r <br />ZIP <br />CONTRACT PR/ID� E OF WORK <br />.A �/•in � � u�wr,w,i. n <br />LICENSE <br />DE CRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />• •�'+....... v. V 1 on. u OHA Lti J CLG11111i LJ <br />C a i' i n r'• e n <br />CONTACT PERSON AND PHONE NO. <br />a _ <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY ';O 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 />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />X iC <br />SIGN RE DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) I <br />A/C-A/HNDLG UNITS - H.P. <br />BATHTUB <br />, <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) , <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />I <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />VENTILATION FAN <br />LAUNDRYTRAY <br />I <br />RANGE HOOD <br />, <br />I <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />I <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />I <br />SINK (SERVICE -BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />GAS PIPING <br />I <br />i <br />EXHAUSTFAN <br />' <br />I <br />� <br />' <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT $ <br />I <br />PERMIT S <br />, <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />I <br />vn vrrwc a�ac VIYLT. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />�lz <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />❑YES ❑ NO <br />BUILDING <br />I <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLOG/TI. <br />UNITS <br />PLUMBING <br />OCCUPANCY NO. OF STORIES <br />GROUP <br />OCCUPANT LOAD <br />BASEMENT <br />I <br />MECHANICAL <br />❑YES ❑ NO <br />FIRE ALARM REO'D <br />REASON <br />ADDITIONAL PLAN CHECK <br />i <br />� <br />i <br />OTHER <br />FIRE SPRINKLER REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST. <br />VED BY <br />CITY <br />jDATE/,9 <br />OF EVERETT <br />PUBLIC WORKS <br />1 <br />LOCAL SALES <br />/ - % 6 <br />TAX CODE IS 3105 <br />TOTAL <br />- <br />a <br />