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APPLICATII.diI FOR CONSTRUC'1.ON PERMIT <br />CITY OF EVERETT - BUILDING DIVIS0N <br />2200 CEDAR STREET, EVERETT, WA 98201 - 259-8810 <br />i I DEMOLITION i I COMBINATION i! BUILDING I I MECHANICAL I I PLUMBING <br />PROJECT ADDRESS <br />OWNER <br />1✓ *VA AI <br />MAIL ADDRESS <br />laos- EveRvrr <br />CITY <br />E✓tetrtrr <br />ZIP <br />!9-ipf- <br />ONE 7J'7� <br />raec) <br />of L <br />- <br />TENANT <br />MAIL AODRE55 way <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAILADDHE55 <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />♦M Sit,ve <br />MAIL ADDRESS <br />CITY <br />ZIP <br />79/73 <br />PHONE <br />J'9o•t'8e3 <br />STATELICENSE- <br />s�sie o�l�a/ <br />t^77,<F <br />rnumecrna <br />ulna nnnRF SS <br />Cltt <br />ZIP <br />PHONE <br />STATE LICENSE II <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSED <br />CONTRACT PRICE OF WORK w" I HEATING SYSTEM: ❑ GAS � I ELECTRIC ❑ <br />dvvv <br />DESCPIBE WORNA SOU Ef0 TA INVOLVED A <br />:�MMf� <br />CONTACT PERSONANOPHONE No. — <br />S&RR TioiLs..',A <br />50 <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 <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 PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANN' <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 WAG. <br />PARCEL TAX I.D. NUMBER <br />X _— • c/ — <br />/ <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNAIR 'Tfi �''d/ <br />IL� <br />CITY BUSINESS LICENSE NO. _ <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />; <br />LAVATORY (WASH BASIN) <br />. <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />�— <br />EXHAUSTFAN <br />' <br />I <br />I <br />I <br />-- <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE S <br />' <br />FOR UhhlUt UJt UIVLT: <br />RECEIPT NO <br />FRONTSETBACK <br />EAR SETf1ACK� <br />„ <br />DE BACK <br />/ 7 <br />PLAN CHECK NUMBER FEE <br />/ <br />L. <br />G <br />131 � <br />�L//'//, � <br />FEES <br />VALUATION <br />FEE <br />U <br />LOTARA <br />VACANT SITE <br />I <br />v <br />❑YES ONO <br />BUILDING <br />HEIGHI MMITATION <br />NO. OFDWEWNG <br />SIZE OF BLDGITI. <br />UNITS <br />PLUMBING <br />MECHANICAL <br />OCCUPANCY <br />NO, OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />I <br />❑YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />�— <br />i <br />FIRE ALARM RED <br />REASON <br />OTHER <br />STATE BUILDING SURCHARGE <br />' <br />I <br />; I <br />FIRE SPRINKLER REO'D <br />REASON <br />PUBLIC WORKS <br />i <br />' <br />TYPE OF CONST <br />PLANS BY <br />CITY OF EVERETT <br />l <br />APROVED <br />LOCAL SALES <br />r�_A1 <br />C <br />TAX CODE IS 3105 <br />TOTAL <br />,SO <br />DATE <br />