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APPLICATLAI FOR CONSTRUC' dON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING X SIGN <br />PROJECT ADDRESS <br />S..vi- EI/ERE" AArRLL Lld 4� , SV I i � IOb EUErZF- <br />iCILNER MAILADDRESS CITY ZIP PHONE <br />TENANT MAILADDRESS CI 21P HONE <br />iLEIFf'Coo&wz(f �5'63 S•W. 6VTr.il YI LLLVT4y EUI;i2a7r VU17-E lob, rfffAo3 <br />GENERAL CONTRACTOR <br />MAILADDRESS U <br />CITY <br />ZIP <br />- FHONE <br />STATE LICENSE <br />gE/Zp-yNg�oNtvO <br />P.o,BaX S21-`% Lyrjnwcod <br />WA-9Xoy6 <br />776-51935 <br />£3E1<91(lvc0770^1% <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />cq"TRC PRI/ OF O6K ,p _ 77 <br />HEATING SYSTEM: El El ELECTRIC 1-1 <br />DESCRIBE WORK AND souARE FOD EINVOLVED <br />INS%l9LL `/S /V .Ep—jOr- <br />CONTACT PERSON AND PHONE NO. <br />1=*VL.70lV <br />LL=7-rF ON Ek -EgiDle RNCIC-WWAL(-oN <br />gLDG (-YaGli� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AI.L <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 />`� / �j - <br />X � �% 6 " /0 - / <br />PROPOSED USE OF BUILDING <br />/QE IDUS O /ILDING 12ES S S/4L rS <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />13�- <br />LOT 1-2-3-',^I BLOCK OF <br />�T <br />J j' Fs <br />PARCEL TAX I.O. NUMBER <br />IM—cc0-0aI^o00E N11?fiCNtD <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE p zy 786 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 FIXTURE OR ITEM <br />FEE _ <br />WATER CLOSET (TOILET) <br />I <br />A/C —A(HNDLGUNITS —H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRYTRAY <br />I <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />WATER HEATER <br />' <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />GAS PIPING <br />' <br />EXHAUST FAN <br />' <br />I <br />' <br />SUBTOTAL $ <br />; <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CK NUMBER <br />FEE 3s <br />RECEIPT <br />GIJ7,17 <br />USEZ.ONE �1 ' <br />LOTAREA <br />VACANT SITE <br />FEE$ <br />VALUATION <br />FEE <br />BUILDING <br />77 <br />( <br />C//,� <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDG/T.I. <br />UNITS <br />PLUMBING <br />' <br />OCCUPANCY <br />NO, OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />GROUP <br />I <br />❑YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />I <br />FIRE ALARM REO'D <br />REASON <br />OTHER <br />FIRE SPRINKLER REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />1 - <br />� I <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />Q <br />SALES <br />�LOCAL <br />�E <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />DATE <br />