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Akj'A r" <br />APPLICATIOrd FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA//98201 •259-8810 <br />DEMOLITION Fl COMBINATION Fl BUILDING F�XMECHANICAL Fl PLUMBING Fl SIGN <br />PROJECT ADDRESS w` L- C IOr <br />OWNER AIAILA RE55 � CVITYa� ZIP PHONE %J 'lam <br />TENANT LADEIRESS 6so S Vv L�V�',V'i� LL II{'] i,- (/J&" X'A M4`v1/,Or lo(, <br />ARCHITECT OR DESIGN \L A/1D0/R^EJ`lr/(J S$„/ 9���� ZIP PHONE I <br />GE AL CONTRA'CCTOOR IJT NllLSA00RE55CITY ZIP S PHONE STATE LLL'CENIJ\ r <br />CITY <br />PLUMBING <br />ZIP <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: Fl GAS Fl ELECTRIC fl <br />DES 1,13 WpRK <br />AND 50UA EFQ <br />CONTACTPQi/)GEINVOLVEO SON AND PHO NO. <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 SZ8D2E7AND I COMPLY WITH THE STATE <br />CONTRACTORIA RCW AND 211,200 W7A//QI . <br />X / (Y C <br />PROPOSED ZOOFB ILOING /�, <br />LEGAL DESCRIPTION OF PROPER (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT' BLOCK GF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />SIGNATUR DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -A/HNDLGUNITS -H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />1 <br />VENTILATION FAI-I <br />' <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />_ <br />GAS RANGE <br />' <br />GAS PIPING <br />' <br />i <br />EXHAUSTFAN <br />i <br />SUBTOTAL $ <br />SUB TOTAL $ <br />; <br />PERMIT S <br />1 <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NU BF.R <br />FEE <br />RECEIPT NO. <br />O <br />USE ZONE <br />LOFAREA <br />VACANT SITE <br />_27O <br />FEES <br />VALUATION <br />FEE <br />f1YE5 fl NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGTTI <br />PLUMBING <br />, <br />i <br />UNITS <br />OCCUPANCY NO OF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECIIANILAL <br />f1YES I7 NO <br />ADDHIONAL PLAN CHECK <br />, <br />i <br />i <br />FIRE ALARM RED <br />REASON <br />OTHER <br />D Vc) <br />FIRE SPRINKLER REDO <br />REASON <br />i <br />STATE BUILDING SURCHARGE <br />i <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLICWORKS <br />LOCAL SALES <br />TAX <br />TOTAL <br />UI 00 <br />DATE <br />CODE IS 3105 <br />l Rl-0 -y ('o <br />