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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 9269-8810 <br />❑ DEMOLITION ❑ COMBINATION '-1 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />JQOJECT ADDRESS: 11$ v����L T4V� <br />I4jy16:SZTZ .3� F&q&0-4L AuTz h� f(-1 9g�� ZS 2—�SCoY <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE, <br />AUUNt S] CITY ZIP PHONE STATE LICENSE 1 <br />AN bb <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: AS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />Q <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 IS MADE AND I -COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 D 296.200 WAC. /- <br />✓ — Id - y-& <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SIO M BELOW OR ATTACH TWO CONES) <br />LOT BLOCK DF <br />PARCEL TAIL I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SKIN LIRE DATE <br />TY 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 />I <br />A/C-A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />Y <br />HEAT PUMP <br />I <br />SHOWER <br />UNIT HEATERS <br />' <br />-4' <br />KITCHEN SINK 6 DISP <br />i <br />- <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD s <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER IM <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />) <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE - BAR, ETC.) <br />1 <br />GAS PIPING <br />I _ <br />' 7�1 <br />EXHAUST FAN Mai <br />SUB TOTAL <br />S <br />; <br />SUB TOTAL S <br />PERMIT <br />$ <br />I <br />PERMIT S <br />�S I <br />TOTAL FEE <br />$' <br />_ Alf, <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />sa�� <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />) <br />HEIGIITUMITATION <br />NO OF DWELUNG <br />UNITS <br />SIZE <br />OF BLDORI <br />PLUMBING <br />OCCUPANCY <br />GROUPMECHANICAL <br />I NO 01111011 <br />OCCUPANTLOAD <br />BASEMENT � <br />❑YES ❑ NO <br />ADDINONAL PLAN CHECK <br />FIRE SPRINKLER REO'D <br />REASON <br />OTHER ',, <br />I <br />i <br />FIRE ALARM REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF C,ONST <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES` <br />TAX CODE IS 3105 <br />PIIBI IC WORKS <br />r <br />—1— <br />TOTAL <br />