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APPLICATIOA FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />f 1 DEMOLITION Il COMBINATION Fl BUILDING 1 MECHANICAL h" PLUMBING f l SIGN <br />PROJECT ADDRESS <br />a�5 <br />OWNER MAIL ADDRESS <br />MAII. <br />q- <br />St <br />MECHANICAL CONTRACTOR MAILADDRESS <br />I /� <br />F alm n i Nic <br />PLUMBING <br />CITYH'lT7yJn) <br />CONTRPf,'OR MAIL ADDIRESS <br />{ tN'7I'nu71/ If /mbi . /V� C-e 7o <br />CITY <br />CONTRACT PRIG OF WORK I-L <br />DESCRIBE WORK AND SOLARE FOOTAGE INVOLVELLD <br />.m b d /Cr JioP <br />/ <br />Tar La iD ��v �c� <br />PROPOSED USE OF BIIILOING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL 7AK LD. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDPESS. TELEPHONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />, <br />CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />, <br />SINK (SERVICE - BAR. ETC.) <br />, <br />i <br />SUBTOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />Zw PITONS STATE LICENSE. <br />ZIP PHONE STATE LICENSE D <br />�� -Gs� �� C'an�•7unso�3oo <br />ZIP PHONE STATE LICENSED <br />HEATING SYSTEM: IIGAS fIELECTRIC fl <br />CONTACT PERSON AND PHONE NO <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 OPDINANCES CCVERNING THIS TYPE OF <br />WORK WILL BE COP.4FLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATF OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW HEGULATING 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 />APPLIC ION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />f P',I -� <br />SIGNASURE v� DATE <br />CITY BUSINESS LICENSL NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C-A/HNDLGUNITS -H.P. _ <br />_ FORCED AIR SYSTEMS - B.T.U. M E.A. <br />_ HEAT PUMP <br />UNIT HEATERS - B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN , <br />RANGE HOOD , <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) —'— <br />FIREPLACE INSERT (WOOD BURNING) �— <br />_ GAS FIREPLACE <br />GAS RANGE T- <br />Ci GAS PIPING C �L , <br />EXHAUSTFAN I <br />SUB TOTAL S <br />PERMIT S -� <br />, <br />TOTAL FEE S <br />I HUNI SETHACK <br />REM SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />FrVALUATION-FE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />_ <br />AYES I NO <br />BUILDING <br />))EIGHT LIMITATION <br />NO OF DWELLING SIZE OF OLDGRI <br />I1NII5 <br />PLUMBING <br />OCCUPANCY NO DI SlnRLS <br />GROUP <br />OCCUPANT LOAD BASEMENT <br />MECHANICALI <br />IYES 11 NOFIRE <br />ALARM REDD <br />PFASON <br />ADDITIONAL PLAN CHECK <br />DTHER <br />FIRE SPRINKLERREOD <br />REnSON <br />STATE BUILDING SURCHARGETYPE <br />OF CONST <br />PIANSAPPPOVEOpY <br />CITY OF EVERETT <br />PUBLIC. WORKS <br />LOCAL SALESDATE <br />TOTAL <br />TAX CODE IS 3105 <br />