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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 Fl COMBINATION KBUILDING Fl MECHANICAL Fl PLUMBING Fl SIGN <br />PROJECT ADDRESS i4M s,r pAu✓� /Aa/' ! PB, rreit.�r�� 9Q208 <br />0110 <br />GE ER-� L ^CTO . ES/(// //l� �O CIiiG/� Ara <br />r ZI�4 C /W1N" Si%/%IV✓�I ,r37kb <br />MECHANICAL CONTRACTOR MAIL ADDRESS • CITY ZIP PHONE STA-E LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />CO iRACi RICE OF WORN <br />;O4 <br />HEATING SYSTEM: [I GAS IkELECTRIC Fl <br />DESCRIBE WORK AND SQUARE FOOTAGE INV LVED <br />spa <br />CONTACT PERSON AND PHONE NO <br />C C �Y <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 i0 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 <br />PROPOSED U E OF,Bu DING, <br />/ <br />LEGAL DESCRIP ON OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF .- <br />/ _ <br />zmor- S�(� •?% <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ACDRESS, TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C -A/HNDLG UNITS-H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS - B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE - BAR. ETC.) <br />I <br />GAS RANGE <br />' <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT $ <br />I <br />PERMIT S <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK I RFAR SETBACK I SIDE SETBACK PLAN CHECK NUUI3F.R FEE _ RECEIPT N0. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />- FEE5 <br />VAALLUAIIUN <br />rcc <br />BUILDING <br />JpQ J <br />I <br />— <br />EIYES II NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGRI <br />I <br />UNITS <br />/ / <br />(i l0 <br />PLUMBING <br />1 <br />T <br />OCCUPANCY <br />NO OF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICALGROUP <br />' <br />— <br />ITYES 11 NO <br />ADDITIONAL PLAN CHECK <br />I <br />FIRER ARM REO'D <br />REASON <br />£S <br />�XIJT/NI 3YSTCM <br />OTHER <br />FIRESrRNKLER REO'D <br />REASON <br />I <br />C <br />�eF lsrl Nr, <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PLANSA <br />RttOVED DY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />- <br />DATE <br />lln i <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />