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APPLICAT101s4 FOR CONSTRUCTIsiN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />PROJECT ADDRESS: 59) /3 E <br />1-h nC. O D 8D x- <br />L <br />❑ BUILDING ❑ MECHANICAL <br />TENANT MAIL ADDRESS CITY 7IP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 711` PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY III• <br />R-11 LUMBING ❑ SIGN <br />Y.� <br />STATE LICENSE <br />MECHANICAL CONTRACTOR MAILADORESS CITY ZIP PHONE STATE LICENSE <br />Y— <br />MAIL ADDRESS <br />- 27-1 <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS <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 />X <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT M 2 BLOCK of <br />27.- 3432-- 005 - O00 - LEI USA <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />;F <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />tJ <br />i <br />' <br />—A/HNDLG UNITS Sltl <br />' <br />Z <br />BATHTUB <br />! <br />; <br />_A/C <br />FORCED AIR SYSTEMS._ ±� <br />LAVATORY (WASH BASIN) <br />II <br />f <br />I <br />HEAT PUMP <br />SHOWER <br />y)1 <br />I <br />HEATERS <br />Z <br />KITCHEN SINK 8 DISP <br />11 <br />_UNIT <br />CLOTHES DRYERS -� <br />DISHWASHER <br />S <br />! <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />) <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) dik <br />i <br />_ <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />I <br />Wµ}(n• Qµ,([.T` <br />EXHAUST FAN <br />' <br />I <br />I <br />I <br />I <br />1 <br />SUB TOTAL <br />S <br />_ SUB TOTAL $ <br />PERMIT <br />f <br />PERMIT f <br />I <br />TOTAL FEE <br />S <br />' �, <br />)� TOTAL FEE $ <br />1' <br />FOR OFFICE USE ONLY: m <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />S'-1 d g <br />USEZONE <br />LOT AREA <br />VACANT SITE ? <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />I <br />_ <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG TI <br />) <br />UNITS <br />PLUMBING <br />_ <br />OCCUPANCY NO OF SIBRES <br />OCCUPANT LOAD BASEMENT <br />MECHANICAL <br />CUP <br />OYES ❑ NO <br />FIRE SPRINKLER REO'D <br />REASON <br />ADDIIIONAI PI AN CHECK <br />i <br />OTHER <br />I <br />• <br />FIREALARMREO'D <br />REASON <br />STATE BIPLOING sI1nC11AnGE <br />I <br />TYPE OF P,pNST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PHBIICWOnKsLOCAL <br />lar <br />fTAXC0DEIS310S <br />SALESDATE <br />TOTAL <br />%U ) <br />