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APPLICATIC -J FOR CONSTRUCT _.)N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />( ❑ UILDINGG� MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: /40� -V �V� <br />_lam-yco�Tt <br />r�y�\\ <br />CU�ao-k* <br />O ER <br />MAILADDRESS <br />CITY <br />ZIP t <br />PHONE <br />TENANT 1J <br />MAII.AODRESG <br />CRY <br />71P <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />GENERAL CONTRACTOR <br />MAILA`DDRE�SS <br />CITY —r— <br />ZIP <br />PHONE <br />STATE LICENSES <br />is (f) <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC F. <br />DESCRIB WORK AND SOU ARE FOOTAGE INVOLVED <br />07 <br />CONTACT PERSON AND PNONE <br />©vl�) ��- <br />1 HEREBY CERTIFY THAT I HAVE REA^ 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 />AUTHOR CY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE-OF,pONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF"THIS PROPERTY'TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS -MADE AND I M Y WITH THE STATE <br />CONTRACTOR LAW 19.27 RC AND.290 WAC. <br />SI L�W <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PnOPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />T <br />A/C —A/HNDLG UNITS <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />I <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />RANGE HOOD <br />I <br />DISHWASHER <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />I <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />_ <br />PERMIT <br />$1 <br />PERMIT $ <br />'I <br />TOTALFEE <br />$1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RE CFIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />—� <br />I <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />— <br />PLUMBING <br />UNITS <br />OCCUPANCY <br />140 DI STONES <br />O CCUPANTLOAD <br />BASEMENT <br />GROUP <br />MECHANICAL <br />OYES ❑NO <br />ADDITIONAL PLAN CIIELN <br />--'— <br />FIRE SPRINKLER RA'D <br />Rf ABON <br />OTHER <br />_—_ <br />FIRE ALARM RED <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF C,ONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />Pt RI IF. wonKs <br />— <br />LOCAL SALES <br />---- <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />