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APPLICATIO.. FOR CONSTRUCTWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 OgLr <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUMBING El SIGN <br />PROJECT ADDRESS: ...6j i31) r IZY� Y11 i S f-. �7ve-A- t <br />DWN�y��r7 ►�RESS O "Jx 79'3 CITY —�-- <br />MML ADDZIP' PHONE <br />1ne 71P <br />AFICHITECTORDESIGNER MATLADORESS CITY )II• <br />IA)' (T. I Ia_Y'Y, <br />PHONE <br />PHONE <br />-bzU -SZV <br />NIAR LICENSE <br />MECHANICAL CONTRACTOR MAILADDRESS Cltt ZIP PHONE STATE LICENSE <br />fl%vLh <br />PLUMBINGC TM RACTOR "'� uM,Amocee `��- `� W ✓"� j1 3 I+ <br />_._. ZJ Mai- iE0 7s✓n)-- <br />•^�^� STATE LICENSE <br />7 . <br />CONTRACT PRICE OF WORK <br />—.— GVG -y aL'YJ v, 10 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE W VOIVED <br />CONTACT PEnSON AND PHONE 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 />PROPOSED USE of BUILDING - <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEHEIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT -- OF <br />NOT. THE GRAN, ING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY <br />—_BLOCK <br />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 />�Z- 3G32^ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />DOS- 000 - 01 OS" <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER - <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />X <br />SIGNATURE 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 EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET (TOILET) <br />UNITS <br />, <br />Z <br />BATHTUB <br />; <br />_A/C-AMNOLG <br />FORCED AIR SYSTEMS <br />'Z <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />' <br />HEATERS <br />, <br />'L <br />KITCHEN SINK 8 DISP <br />_UNIT <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />, <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />, <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />GAS FIREPLACE <br />, <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />' <br />SINK (SERVICE - BAR, ETC.) <br />GAS PIPING <br />, <br />, <br />Y <br />' <br />EXHAUST FAN <br />, <br />I <br />, <br />, <br />1 <br />SUB TOTAL S <br />SUB TOTAL $ <br />' <br />PERMIT S <br />, <br />PERMIT S <br />, <br />, <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />run urmut UJt ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE_____._ <br />_ <br />DYES ❑ NO <br />BUILDING <br />Iw <br />' <br />HEIGHT LIMITATION <br />NO. OF DWELLING SIZE OF BLDGRI <br />PLUMBING <br />JJ I <br />UNITS <br />OCCUPANCY NO OF STORES <br />OCCUPANT LOAD BASEMENT <br />�— <br />OR <br />MECHANICAL <br />, <br />❑YES ❑ NO <br />— <br />ADDITIONAL PI AN CHECK <br />i <br />FIRESPRINKLERREO'D <br />REASON <br />OTHER <br />i— <br />FIRE ALARM REDO <br />REASON <br />STATE OIIIIDING, 511RCIUBOE <br />TYPE OF CONST <br />PLANS APPROVED BY <br />OF EVERETT <br />PIIRI IC, WOIIKS <br />- <br />I:TA;X <br />CALSALES <br />TOTAL <br />-- <br />DATE <br />CODE IS 3105 <br />