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APPLICATIO.. FOR CONSTRUMiN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />047-r <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: SOS S� za�-L Ina/l 6i'j- <br />ti <br />GNrI ioTt�'!I ,»ram i'B/O/ l ZcG� lg� - 3/aD <br />OWNER MAI DORE SS CITY LIP PHONE <br />-rlLr <br />��� � <br />TENANT MAILADDRESS CITY ) 71P PHONE <br />/ u� ✓ANr✓Y P,� lei n,' !di' c3E21EyriG ,'B�s Czv�> S� - os��y <br />_ <br />ARCHITECT OR DESIGNER MAIL AOPRESS CITY lIt• PHONE <br />Ji7P7r�rn / / r'7''�`A ����ro.✓�59 l7aSi <br />GENERAL CONTRACTOR MAIL ADDRE SS CITY 71P PHONE STATE LICENSE( <br />-� 9 f4r1 M3 Ha <br />MECHANICAL CONTRACTOR MAILAODRESS CITY LP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAILAODRES$ CITY ZIP PHONE STATE UCENSEF <br />�2oX G�?J <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />`T /. Lx/ice ISGZ� s <br />CONTACT PERSON AND PHONE NO <br />-air or= F <br />I <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />P $ED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK of <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 COMPLY WITH THE STATE <br />PARCEL TAX I.D. NUMBER <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />/n / <br />X <br />SIGNATURE 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 EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEAT ERS <br />' <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />' <br />EXHAUST FAN <br />( <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL S <br />; <br />SUB TOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REM SETBACK <br />SIDE SETBACK <br />PLAN CHECK N'UM/DFR <br />FEF <br />RECFIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />[BUILDING <br />DYES O NO <br />NO OF DWELLING <br />SIZE OF BLDGff1 <br />HEIGHT LIMITATION <br />PLUMDING <br />UNITS <br />1 $-00 <br />' <br />OCCUPANCY NO Or 90RIf5 <br />' <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />S�/ <br />❑vE5 NO <br />— <br />FIRE SP INKLER REO'll <br />ADDITIONAL PLAN CIIECK <br />REASON <br />y�S <br />�E LS Fla <br />—(---- <br />OTHER <br />REASON <br />FIRE ALARM REO'D <br />SLAT E OLu1 DING SHnCIIARGE <br />AJID <br />7 <br />I <br />TYPE OF P,ONST <br />PLANS (ROVED BY (� <br />CITY OF EVERETT <br />runllr, wonKs <br />V , A / <br />LOCAL SALES <br />- <br />V <br />DATE /�- -� L <br />TAX CODE IS 3105 <br />TOTAL <br />