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APPLICATIOd FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />CI DEMOLITION td, COMBINATION FyDWLDING ^MECHANICAL �LUMBING fl SIGN <br />PHONE <br />MAIL ADDRESS CITY <br />PHONE STATE LICENSE • <br />STATE LICENSE • <br />FACTOR MAIL ADDRESS CITY ZIP <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: GAS I -] ELECTRIC (l <br />DESCRIBE SQUARE FOOTAGE INV VED <br />CO ACT PERS AND PHON NO. <br />d <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 />PROPOSED USE OF BUILDING <br />413 L_z ne"Ac _ <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NO' PRESUME TO GIVE <br />LE AL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT _ BLOCK of <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 />CONTR� IRS2LA 18.27 CW A 296.2000WAC.CONSTRUCTION <br />/LE <br />p X LD. NUMBER <br />LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />I( DATE" <br />• (.NY f� <br />�/_�/�_ <br />SIG TURE <br />CITY BUSINESS UCENSE NO <br />MECHANICAL <br />_ <br />PLUMBING <br />FEE <br />NO. TYPE OF FIXTURE OR REM sL. FEE <br />NO. <br />G <br />_TYPE OF EQUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />WATER CLOSET(TOILET) <br />' <br />' <br />21 <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_. <br />BATHTUB. <br />I <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />! <br />' <br />SHOWER <br />�' ' �, <br />, O <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK d DISP <br />I <br />CLOTHES DRYERS • <br />�` ' <br />' <br />DISHWASHER <br />' <br />$ <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />i <br />(J <br />WOOD STOVE <br />I <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />' <br />0 <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />BACKFLOW PREVENTERS <br />; LJ <br />! <br />GAS FIREPLACE <br />' <br />O <br />SINK (SERVICE — BAR. ETC.) <br />- <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />' <br />1 <br />1 <br />I <br />SUBTOTAL $ <br />; <br />_, <br />SUBTOTAL $ <br />PERMIT $1 <br />PERMIT $ <br />' <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLT: <br />FRONT SETBACK <br />�v <br />USE ZONE <br />/7 <br />REAR SETBACK <br />yd , <br />IOT AREA <br />Q 7� <br />SIDE SET ACK� <br />VACANL E <br />I VES f I NO <br />PLAN CHECK NUMBER FEE <br />FEES <br />VALUATION <br />RECEIPT NO <br />FEE <br />BUILDING <br />OW <br />' <br />HEIGHT LIM'TATIOy / <br />N0. OF DWELL) <br />UNITS / <br />SRE OF 8 SElR \ <br />/It?e G4AAr,E <br />PLUMBING <br />/ <br />MECHANICAL <br />-r <br />OCCUPANCY <br />GROUP <br />K-3/ti•/ <br />NO Of STORIES <br />OCCUPANT LOAD BASEMENT <br />(,YES ND <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RED <br />REASON <br />OTHER <br />FIRE SPRINKI. ER REGD <br />RFASON <br />STATE BUILDING SIIRCIIARGE <br />N <br />PUBLIf, WORKS <br />2G' <br />TYPE OF C,ONST <br />PIANSAPPROVED By <br />J. <br />CITY OF EVERETT <br />LOCAL SALES <br />_ <br />N <br />DATE 2 z�/iS <br />TAX CODE IS 3105 <br />TOTAL <br />