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APPLICATIGA FOR CONSTRUCThJN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ !;Wff <br />DEMOLITION, ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />PROJECT ADDRESS: /��� _� C° �7i`. YJi/a00. 211 " . .%, v <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />F VIA!2 zcsnv]L <br />3.,IS //S <br />ii 2Ye SE /c&j� <br />W,4 9zvyas <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />�s <br />' <br />i #�1I LARI/IT <br />ifllL! lJirfi(.F/i1 <br />ARCHITECT OR DESIGNER <br />DESIGNER <br />AIAII A RESS <br />CITY <br />]IP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL <br />CITY <br />TIP <br />PRONE STATE LICENSE � <br />lls�94;ezl <br />/ADD�RES-S <br />wy .31c/y <br />20 <br />6OV-y77-7y5yG AcWiM 115o710411 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE IF <br />PLUMD O NIRACTGR <br />MAIL ADDRESS <br />CItY <br />ZIP <br />PHONE STATE LICENSE • <br />WA <br />CONTRXCT PRICE OF WORK <br />r <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT ERSON AND P110NE NO <br />-U <br />7y <br />A <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 PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />F _RFORMANCE 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(i���'1i-a-c-r�-�-97 <br />P seo USE BUILDING - <br />LEGAL DESC IPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL T0.4! 0. NUMBER <br />CONSTRNUCTION' nLOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />1YI1 ` <br />SI ATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A/HNDLG UNITS <br />T- <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />_ <br />SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />_KITCHEN <br />D.ShIWASHER <br />I <br />RANGE HOOD <br />i AUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />D'AINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />i <br />SUBTOTAL S <br />; <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SF tOACK <br />SIDE SETBACK <br />PLAN CN[CK NUMSEF <br />RFCEIPi NU <br />USE ZONE �//'� <br />LOT AREA ]J� k6}'*Z3 <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES .dNO <br />OUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLCG]TI <br />L_I �L <br />UNITS \� <br />V <br />PLUMBING <br />' <br />OCCUPANCY <br />NO OF SIORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />GROUP <br />I <br />DYES ❑ NO <br />ADOI IIONAL PL AN CHECK <br />i <br />FIRE SPRINKLER REO'D <br />I9FASON <br />OTHER <br />-- I <br />FIRE ALARM REO'D <br />RFASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PI ANS APPROVED BY <br />CITY OF EVERETT <br />PIIBI ID WGRKs <br />' <br />i/I <br />I �lj/�% <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />-72 <br />DATE <br />_ <br />