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APPLICATILA FOR CONSTRUC1,0H PERMIT <br />CITY OF EVERETT • MILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />1 i PLUMBING I-) SIGN <br />I-) DEMOLITION fl COMBINATION FI BUILDING MECHANICAL <br />PROJECT ADDRESS E EVC %C-e f1'%q4Q r/ „ c, <br />OWNER , MML/�DDRESS <br />/'a, CITY ZIP I PHONE <br />3a�fi <br />TENANT MIL ADDRESS CITY ZIP PHONE <br />ARM OR DESIGNS MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR ..I} MAIL ADDRESS CITY ZIP �� HONE � STATE LICENSE <br />v[O ✓Y.J�aw.s <br />MECHA CAL CONTRACT R MAIL ADDRESS CITY ZIP PHONE STATE LICENSEM <br />SrF��e iYllc�L Z"I G st5&j AUA)fl / G'23/4f/�—KAocE0 LcJ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: XGAS FIELECTRIC n <br />DESCRIBE WORK VD SQUARE FOOTAGIf INVOLVED <br />r1 <br />CONTACT PERSON AND PHONE N0. � ^ <br />Da % a( <br />//CIS I I KJ V>Ly IJ <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 />PROPO" ED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PPOPERTV (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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X - DATE <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />31GNATUR <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />' <br />I <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS —H.P. <br />' <br />FORCED AIR SYSTEMS —B.T.U. M E.A. , <br />BATHTUB , <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />' <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />—'— <br />KITCHEN SINK 8 DISP <br />' <br />DISHWASHER <br />VENTILATION <br />, <br />— <br />LAUNDRY TRAY <br />' <br />' <br />RANGE HOOD <br />' <br />I <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />URINAL <br />' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS FIREPLACE <br />-T— <br />SINK (SERVICE —BAR, ETC.) <br />GAS RANGE <br />, <br />) <br />GAS PIPING <br />EXHAUST FAN <br />' <br />, <br />, <br />, <br />, <br />—�_ <br />SUB TOTAL S <br />, <br />i <br />SUB TO'(AL S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL' FEE S <br />I <br />FOR OFFICE OFFICE USE ONLY: RECEIPrNo. <br />FRONT SETBACK REAR SETBACK 510E SETBACK I PLAN C11ECNj� MjlFO� <br />FEE <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />rcw <br />❑YES ❑ NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO.UNIOF DWELLING <br />SIZE OS F BLDGRI. <br />1 <br />PLUMBING <br />MECHANICAL <br />OCCUPANCY <br />NO OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />AYES n NO <br />ADDITIONAL PLAN CHECK <br />FIREALARM REO'D <br />REASON <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />FIRE SPRINKLER REO'D <br />REASON <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I TOTAL <br />