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PLOb <br />19 APPLICATIE^1 FOR CONSTRUCT 3N.. <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, 6VA 982G1 •259-8B10 <br />❑ 7EMOLITION ❑ COMBINATION ❑ Bt'1ILDIiVG ❑ MECHANICAL <br />�i+Arrr�s-Ic Sknts <br />,TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 711, PHONE <br />PER11r11'' <br />. f PLUMBING fl SIGN <br />GENERA. CONTRACTOR MAIL ADORE 55 CNY ID PHONE STATE LICENSEE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY Z,P PHONE STATE LICENSEE <br />PRCFfis5LDAiAL.. FW, ljF;(25 TD �JC. �. RW Q)V C'A/'.Jar,n..l �. nIU <br />CONTRACTOR <br />PRICE <br />,.co,,nrot EEUHK AND SQUARE FOOTAGE INVOLVED <br />J2'AJi:4 LAJ 4.,110 PP'_PI/1116 P1aMfA:.l7- 1=. <br />CITY ZIP <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CON (ACT PERSON AND PHONE NO <br />t)Ja-7Eg (?t g <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNC:AI THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED NITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF 1, PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOL.A.Tc OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE. 017 CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION 15 MADE AND I COMPLY WITH THE STATE <br />CONTRgCTORS LAW 18.27R/CCW AND 296.200 WAC. <br />X <br />SIGNATURE DATE <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY ISIIOWN BELOW OR ATTACH TVO COPIESI <br />LOT BLACK OF <br />PARCEL TAK LD. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <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 />AIC—A7HNDLG UNITS <br />I <br />BATHTUB <br />; <br />1 <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />, <br />LAVATORY (WASH BASIN) <br />_ <br />SHOWER <br />UNIT HEATERS <br />, <br />— <br />KITCHEN SINK 6 DISP <br />i <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />1 <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />, <br />CLOTHESWASHER <br />I <br />WOCC STOVE <br />, <br />_- <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIRIPLACE INSERT (WOOD BURNING) <br />; <br />i U10R DRAIN <br />I <br />GAS FIREPLACE <br />r <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />, <br />_ <br />EXHAUSTFAN <br />I <br />1 <br />, <br />1 <br />1 <br />) <br />SUB TOTAL <br />S <br />; <br />SUB TOTAL S <br />; <br />PERMIT <br />S <br />1 <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUM//BEER--�� <br />FEE <br />RECEIPT NO <br />71,H <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ❑ NO <br />BUILDING <br />i <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLOG7TI <br />UNITS <br />PLUMBING <br />' <br />1 <br />OCCUPANCY <br />NO OT STDRIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />❑YES ❑ NO <br />ADDITIONAI. PLAN CHECK <br />- <br />FIRE SPRINKLER flEO'D <br />REASON <br />OTHER <br />FIRE ALARM REO'D <br />REASON <br />STALE BUILDING SURCHARGE <br />' <br />' <br />TYPE OF P,ONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PIIBITCWOflKS <br />LOCAL SALES <br />TOTAL <br />—�— <br />DATE <br />TAX CODE IS 3105 <br />