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APPLICATIO•d FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />Fl DEMOLITION Fl COMBINATION Fl BUILDING Fl MECHANICAL P<PLUMBING Fl SIGN <br />PROJECT ADDRESS / 1 /LL-t / t <br />OWNE,,}}Rt MAIL ADDRESS CI P ' PHONE <br />P PHONE <br />TENANT MAIL ADDRESS CITY 21P <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PI10',E <br />STATE LICENSE I <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE e <br />PLUMBING CONTRACTOR <br />0CAf-/ <br />e9i..T//) <br />4?AT r/N C/to/ �% <br />S tw ff /'%[t.[t 2'—J l"Al /_-/ �I It., -w,_ <br />_ _ <br />CO!7C/� OF WURK a O i_ <br />HEATING SYSTEM: FI GAS fl ELECTRIC fl <br />— <br />DESCRIBE WOTIAND SOUARE FOOTAGE INVOLVED <br />CONTA T PERSON AND PM ENO. ^ 1 � <br />t <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 />BUILDING <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 />OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LEGAL DESCRIPTION <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 ROW AND 296.200 WAC. <br />f <br />PARCEL TAX ID. NUMBER <br />CONS7EIUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />X DATE <br />SIGNATURE <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />FEE <br />' <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />_ <br />NO. TYPE OF EQUIPMENT <br />I <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS —H.P. <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />; <br />I <br />CLOTHES DRYERS <br />VENTILATION FAN <br />' <br />( <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />( <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />WOOD STOVE <br />�— <br />URINAL <br />DRINKING FOUNTAIN <br />i <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />T— <br />' <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />I <br />' <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />' <br />I <br />I <br />I <br />) <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $ <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK I REAR SETBACK SIDE SETBACK PLAN <br />USEZONE <br />LOT AREA <br />HEIGHT LIMITATION <br />DWELLING <br />UNITOF <br />OCCUPANCY NO (N STORIES <br />OCCUPANT LOAD <br />GROUP <br />FIRE ALARM RED <br />RFASON <br />FIRE SPRINKLER REED <br />REASON <br />TYPE OF f,ONST <br />PUNS APPROVE( <br />DATE <br />VACANT SITE <br />11 YES 11 NO BUILDING <br />SIZE OF BLDGffI <br />'IYES 11 NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />FEE RECEIPT NO. <br />PLUMBING T— <br />i <br />MECHANICAL <br />, <br />I <br />ADDITIONAL PLAN CHECK _ _— <br />OTHER <br />STATE BUILDING SURCHARGE <br />TIIBHC \STORKS <br />TOTAL <br />