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APPLICATIOwd FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />rT nFlunl ITInNI FI COMBINATION ❑ BUILDING II"MECHANICAL Fl PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />ig02 5E, i✓jEfuriT MALL tr.TALI SP L46—L3 q 6 a <br />nWNgn MAILADDRESS CITY ZIP PHONE <br />7iFa unai {i (407-5 i £- 4M&II Y £�•rai 38ot0�3 I-2d6- 355-54`�'i <br />TENANT MAILADDRESS CITY 21P PHONE <br />ARCHITECTOR DESIGN MAILADDRESS CITY ZIP PHONE <br />1UOTT.Q• <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE II <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: (OVGAS []ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />l(AV <br />Q <br />KJu C e. <br />n <br />+� <br />n <br />-�J 4" <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />Z ma liro <br />w <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PHOPERTY (SHOWN BELOWORATTACHTWOCOPIES) <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 />W i 27 RC AND 296.200 WAC. <br />CONTRRXE <br />PARCEL TAX I.D. NUMBER <br />i - -01 - O <br />c� <br />X <br />CONSTRUCTION LOAN LENOEP, ADDRESS. TELEPHONE NUMBER <br />-SIGN 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 FIXTURE OR IT"E.A.: <br />WATER CLOSET (TOILET) <br />I <br />A/C — A/HNDLG UNITS — H.P.BATHTUB <br />FORCED AIR SYSTEMS — B.T.U.LAVATORY <br />(WASH BASIN) <br />HEAT PUMPSHOWER <br />UNIT HEATERS—B.T.U. MKITCHEN <br />SINK & DISP <br />CLOTHES DRYERSDISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <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 />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />' <br />' <br />' <br />f <br />GAS PIPINGA <br />i <br />EKHAtlB�'Fv{JrQ--C <br />' <br />O <br />i <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />i <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />' <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />' <br />rvn vrruA Q wAo vn�+. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FEES <br />VALUATION <br />FEE <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑YES ❑ NO <br />BUILDING <br />i <br />HEIGHTUMITATION <br />NO. OF DWELLING <br />SIZE OF BLDOIT.I. <br />i <br />' <br />UNITS <br />PLUMBING <br />MECHANICAL <br />' i <br />OCCUPANCY NO, OF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />I <br />❑YES ❑ NO <br />' <br />ADDITIONAL PLAN CHECK <br />I <br />' <br />FIRE ALARM READ <br />REASON <br />i <br />OTHER <br />i <br />FIRE SPRINKLER REDD <br />REASON <br />' <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />i <br />TYPEOF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />; <br />TAX CODE IS 3105 <br />TOTAL <br />' <br />DATE <br />