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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT R BUILDING DIVISION <br />3200 CEDAR STREET R EVERETT, WA 98201 R 257-8810 <br />DEMOLITION ❑ COMBINATION i 1 BUILDING C1 MECHANICAL PLUMBING SIGN <br />APCMITECTORUESGNER MAn ADOREss Cltt Z", IiHONE <br />GENERAL CONNMCIw tlMLADDRESS CITY .R, RGNE SLATE LICENSER <br />MECHANIC LCONTRACTOR MAILADDRESS CITY TIP AKAC STATE LICENSER <br />PLUMBING CONTIUCTm VAn ADOIICSS CITY ZIP AGNE STAIE LICENSER <br />CONTRACT MCE M WIXIK <br />00 <br />HEATING SYSTEM: ❑GAS DIELECTRIC ❑ <br />DESCRIBE WORK AND SGIME FOOTAGE BIY II <br />CONTACT PERSOII AND PIENE NO <br />PROPosEo usE OF eundla <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 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 PCW AND 296.200 WAC. <br />X <br />LEGAL CESCRNTEN OF PROPERTY TBNOIYN BELOW OR ATTACH TWO COi <br />LOT BLOCK Cli <br />IMACEL rAx I o NuueER <br />COHSTROCTTON LOAN LENCEP. ADORESS, TELEPHONE HAMBER <br />SIGNATURE DATE <br />Gtt BUSINESS 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 />A!C—AMNDLG UNITS <br />i <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />j <br />UNITHEATERS <br />j <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />i <br />RANGE HOOD <br />LAUNDRYTRAY <br />! <br />WATER HEATER <br />! <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />j <br />METAL FIREPLACE (WOOD BURNING) <br />j <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />I <br />! <br />EXHAUSTFAN <br />j <br />! <br />I <br />I <br />SUBTOTAL <br />S <br />I <br />SUBTOTAL S <br />I <br />PERMIT <br />S <br />I <br />PERMIT S <br />j <br />TOTALFEE <br />S <br />! <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: _ I <br />FROINT SETBACK <br />REM SETBACK <br />SEE SETBACK <br />PLAN CHECK NUMBER <br />RECENT NO. <br />NA <br />RJA <br />„/q <br />USE zoHE^'/� <br />tf}FA{IE'�'( <br />)�fiwI <br />vACANrOITE <br />❑YES <br />FEES <br />VALUATION <br />FEE <br />BUKdIq <br />�— <br />f <br />HEIIECGG�}��ET LIMITATION <br />/l <br />MIUM <br />O OF DNEuna <br />UNITS <br />MTV <br />sIZEa BIOC✓f 1. <br />�— <br />rLTIaUL <br />MUMBINO <br />OCCUPANCY NO CF STORES <br />GPWP <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />D E8 ONO <br />ADDITIONAL PLAN CHECK <br />FinSPRINKLER PEO D <br />REASON <br />OTHEA <br />FEEAL MRE00 <br />REASON! <br />t <br />STATE WAJ WG SURCHMGE <br />TYREOFCDHSE <br />I S DBY <br />CITY OF EVERETT <br />MOLE WORKS <br />LOCAL SALES <br />TOTAL <br />DATE A 0 D <br />TAX CODE IS 3105 <br />