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APPLICATIN FOR CONSTRUCIII!!bN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 998201 • 259-8810 <br />Cl DEMOLITION ❑ COMBINATION El BUILDING Er/MECHANICAL' ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRL.SS: <br />It u cC l llfl U0 ,W\C . V"(9 N' k\\QNuf, W(A �1 )� 0e)-Y-11(J <br />OWN 7 ADDRESS CITY ,�,ZIP PHONE <br />_ (_per -7io ya/ �� //ul)- - 3/oy <br />TENANT A'AIL ADDRESS CITY ZIP PHONE <br />'7ADD �rn+t4� iVNAe,r,�6,0ttV6 NlblE �ti?,�II�I(�1 <br />ARCHITECT OR DESIGNERI MAIL ADDRESS _ CITY ZIP , PHONE <br />1V1(,, "In u)- -1vLv l_mC1it)h CJ1'f'1 IVY <br />V1t 11" la' 0\1LI-1°u1i ocl-b� VTSUI) <br />GENERAL CONTRACTOR <br />C Me c.H. ,L1,C . <br />MAILADDRESS <br />I -�» uu w- S{" 51 `wB-1 <br />CITY <br />21r <br />PHONE STATE LICENSE a <br />k)( GML-TA C1s <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE II <br />PLUMBING CONTRAC70R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE) <br />CONTRACT PACE OF WORM <br />HEATING SYSTEM: EYGAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SOUAI IE FOITAGE INVOLVED <br />1,')ftL <br />CONTACT PERSON AND PHONE NO <br />rn� <br />�l <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 TO 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 I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.2DO WAC. <br />X / - <br />PROPOSED USEF <br />eoaaNc <br />GL�� <br />.. <br />KC-J ✓C <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK of <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCRON LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGN RE DATE <br />CI SINESS 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 />I <br />( <br />A/C—A/HNDLG UNITS <br />BATHTUB <br />1 <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASP{ BASIN) <br />I <br />HEAT PUMP <br />�— <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />T <br />EXHAUSTFAN <br />iI <br />I <br />' <br />I <br />SUB TOTAL $ <br />; <br />SUBTOTAL S <br />;L ; <br />PERMIT S <br />PERMIT S <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE <br />F:np (]FFICF IISF ONI V• <br />FRONT SETBACK <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFn <br />FEE <br />RECEIPT NO <br />USE ZONE <br />_ <br />tOTAREA <br />VACANT SITE <br />DYES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' I <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF DECOR <br />PLUMBING <br />— <br />I <br />i— <br />OCCUPANCY <br />GROUP <br />NO Of STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />DYES ❑NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />------- <br />i <br />FIRE SPRINKLER REDO <br />REASON <br />OUTER <br />FIRE ALARM REDO <br />REASON <br />STATE BUILDING SURCHARGE <br />Tyr[ OFr.ONST <br />Pt ANS APPROVED nY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PURL IC WORKS <br />TOTAL <br />— -- <br />—1 <br />