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APPLICATICA FOR CONSTRUC? .JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING l sIGN <br />PROJECT ADDRESS: 16 5E Eve¢ ITT lX1 L L .S/AE 57f z-' <br />OWNER IL �C`-MAIL ADDRESS I /J� ,"""'� A7W —Q,, 7PP tYll`l PHONE <br />A Tar SE &Wa? -7- AYdte 1„�V 5a- 7.R- z1,i 1��( <br />TENANT �--�_—LADDRESS CITZIP PIIONE <br />PHONE <br />MAIL <br />MAIL <br />LICENSE F <br />HLUMBING CONTRACTOR MAIL ADDRESS <br />CITY 71P <br />PHONE <br />STATE LK:ENSEa <br />CONTRACTPP/CEOFWORK <br />8 zaiA 7 <br />HEATING SYSTEM: <br />❑ GAS <br />❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SGUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />Za <br />I HEREBY CERTIFY TI.AT 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 I qOMPLY WITH THE STATE <br />CONTRACTORS LAW 18 RCW IUD 6.200 WAC. <br />�(114 <br />PROPOSED USE OF BUILDING <br />CG.GM <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN PILLOW OR ATTACH TWO COPIES) <br />Lot BLOCK of <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />L <br />SIGNA UR DATE <br />2 �l T OC` <br />CITY BUSINESS LICENSE NO <br />PLUMB) G <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 — A/HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />P <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES OF1YERS <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />__ ! <br />_ <br />' <br />EXHAUST FAN <br />I <br />I <br />' <br />I <br />, <br />; <br />SUB TOTAL $ <br />; <br />SUB TOTAL S <br />; <br />PERMIT $ <br />I <br />PERMIT S <br />TOTALFEE $ <br />' <br />TOTAL FEE S <br />eno neeLre "cc nuL v. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CIIECK NIIMnm <br />fEF <J <br />3-/ o <br />nrcrIPTNO <br />A,A <br />,j A_ <br />USE ZONE <br />AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />T'7 <br />i — <br />- / <br />N d <br />Ores a No <br />1 <br />BUR DING <br />� <br />' / <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE Of BLDGRI <br />—J <br />UNIIS •)^ <br />PLUMBING <br />I <br />OCCUPANCY NO (K SI(KtlFS <br />OCCUPANT LOAD BASEMENT <br />MFCf1ANIf.A1 <br />— <br />GROUP <br />❑YES p NO <br />ADDITIONAL PUN CIIECK <br />) <br />FIRE SPRINKLER REG'D <br />RFASON <br />-- <br />OIIIEn <br />FIRE ALARM REO'D <br />REASON <br />STAIE BUILDING SIInCI1AnGE <br />—, <br />PURI'r wOnKS <br />' <br />TYPE OF CONST <br />PIANSAPP gvEn By <br />CITY OF EVERETT <br />b <br />I 1 <br />LOCAL SALES <br />TOTAL <br />// <br />(.: 1 i540 <br />DATE 1 - <br />TAX CODE IS 3105 <br />