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r. <br />APPLICATIOkv FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 4wr <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMbING ❑ SIGN <br />PROJECT ADDRESS: iS ^ •F-tL <br />1.3,hh ..,. �� 2' � ua3 v IRS <br />TENANT MAILADORESS CITY 71P PHONE <br />bZll" -r,-yy <br />PNUNE STATE LICENSE I <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE I, <br />I-f7-G MP,L l- • =L.c.. Z3S- Imo` (1>� Luyu.ItvL�J �33 zz-;w Hzorwer <br />PLUMBING CONTRACTOR MAILAUDRESS CITY IIP PHONE I STATE LICENSE, <br />CONTRACT PRICE OF WORK <br />' <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON ANC?HONE 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 HEREIN OR <br />NOT. THE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />3 <br />GT OF AOR PERMITNOT PRESME TO GIVE <br />LOT _ BLOCK OF <br />AUTHORITY OTVIOLATEING <br />AINCDEOLETHE 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 />- 43z- <br />e z 3 oo s-- oao - o I or <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />PARCEL TAx F.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />X <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE 00. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />'L <br />WATER CLOSET (TOILET) <br />c <br />A/C—A/HNDLG UNITS <br />BATHTUB <br />A <br />�' <br />FORCED AIR SYSTEMS ' <br />LAVATORY (WASH BASIN) <br />, <br />F <br />HEAT PUMP ffMP !M <br />SHOWER <br />HEATERS <br />, <br />KITCHEN SINK &-MSP <br />_ <br />_UNIT <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />, <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <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 />GAS PIPING <br />EXHAUST FAN <br />I <br />, <br />SUB TOTAL S <br />' <br />SUB TOTAL $ <br />' <br />_ <br />PERMIT S <br />I <br />PERMIT S <br />, <br />TOTALFEE $ <br />' <br />TOTAL FEE $ 1' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SE (BACK <br />PLAN CIIECKNUMRCj3, <br />S <br />FEF <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ❑ NO <br />BUILDING <br />' <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGfFl <br />PLUMBING,' <br />' <br />UNIT <br />OCCUPANCY <br />NO as STORES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />MECHANICAL <br />, <br />❑YES ❑ NO <br />ADDIIIONnI. PI AN GIT.CN <br />I <br />FIRE SPRINKLER flED'D <br />PlASON <br />DATER <br />— <br />FIRE ALARM REO'D <br />REASON <br />STATE BUILDING SIIRCIUOGE <br />�F <br />TYPE OF CUNST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PANT IF, WORKS � <br />� <br />LOCAL SALES <br />TOTAL <br />—�— <br />DATE <br />TAX CODE IS 3105 <br />