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APPLICATIGA FOR CONSTRUCToON PERMIT <br />CITY OF EEe E • BUILDING DIVISION <br />Li0 32CEDAR STREET VERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: S%n Z A-� IAn< -ma --.- <br />MAIL ADDRESS CITY ZIP PHONE <br />JAms.5 S00S-NIU4oGs zW626c7-7 5>rz03 ,?`i <br />MAILADORESS CITY nD e..nue <br />rffI <br />v is <br />CONTRACT PIKE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DE WORK A/O SQUARE FOOTAGE INVOLVED <br />77=7 do <br />CONTACT MRS014 AND PHONE NO <br />o v 2 / 1 <br />0�1� <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 P90VISION 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 />IS MADE AND I COMPLY WITH THE STATE <br />NTRACTORS W 15.27 RCW AND 296.200 WAC. <br />X -t <br />PROPOSED OF BUILDING <br />U IQLa_ �J✓ i4 <br />LEMDESCwvnDNOFPROPERTY (SHOMBELOW ORATTACHTWO COPIES) <br />LOT -Z— BLODK OF o A) All 710A) <br />/ 7lo Q U o O O Z QQ Q S_ <br />MAIM TAX I.D. NUMBER <br />CONS LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />A <br />JAPPLICATION <br />_61/ <br />ATURE OAT <br />55 LICENSE NO. <br />PLUMMNO <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 />, <br />A/C —JVHNOLG UNITS <br />1 <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />1 <br />KITCHEN SINK & DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FC UNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />, <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR. ETC.) <br />I - <br />GAS PIPING <br />, <br />EXHAUSTFAN <br />' <br />r <br />, <br />, <br />1 <br />, <br />I <br />, <br />SUB TOTAL $ <br />SUB TOTAL S <br />; <br />PERMIT S <br />, <br />PERMIT $ <br />, <br />TOTAL FEE $ <br />I <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRORT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER ) <br />pos l!/ <br />FEF <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF BLDdLI <br />PLUMBING <br />OCCUPANCY <br />I NO Of STONES <br />OCCUPANT LOAD <br />BASEMENTGROUIP <br />❑YES ❑ NO <br />MECHANICAL <br />Apd110NAL PLAN CHECK <br />4 . <br />I <br />FIRE SPRINKLER REO'D <br />REASON <br />OTHER <br />I <br />FlRE AIAAM REO'O <br />REASONJI <br />STATE 9111LOING SURCHARGE <br />LL <br />TYPE OF fpNST <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 7105 <br />Puaur, woRKs <br />TOTAL <br />