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APPLICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT A DUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 A257-8810 <br />DEMOLITION F-, COMBINATION ❑ BUILDII=3 MECHANICAL PLUMBING -' SIGN <br />PROJECT ADDRESS <br />GWNEa MAILADOPESS Lm FR PHONE <br />LOOK TEi2:NULT aZq IIJW41- Qo, EUI'%. <br />IENAHT 'JAILAWRESS CITY bP PHONE <br />ARCHITECT' DESIGNER MAIL ADDRESS CRY ZIP FHCAIE <br />MAALZY &As14,XZ?01 1y321 aA/ A✓G A14 ntUL �¢,tli 6CI-std 111a4dY<.* 6770A <br />GENERA-CCNTIMCTOR MAILAWNL5b CITY IW PHONE STATE LICENSE <br />MECMANCAL CONTRACTOR MAILAOORESS CITY ZIP NKNAE STATE LICENSE <br />PLVMPlJiih[i &2-y p IlAdl"'. <br />CONl.g MNLADJ11— CITY ZN PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK NO SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE Iw. <br />_RE AaAI4 BATH /AU.i�C } <br />/YJ 5/N ' F C[S OI�Ly <br />M tz /"LO - 3(4•6S1-SLD/ <br />I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV:IONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOHK 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 7HE 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 />CONTRACTORS LAW 18.27 RCW AND 296 200 WAC. <br />x E-23-0 <br />PROPOSED'sr. CF BumlNc <br />S F• RCYLCT �r <br />LEGAL DEuaIPnoNa PRDPEatt RrwvnI BELOW oN A11 ALH IWwcM IEsI <br />LOT BLOCK o< <br />PARCEL TO I D. NUMBER <br />GONSTPUCigN LOANLENCER. ADDRESS. iilEPIwNE NUMBER <br />SIGNATUR[ 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 />AIC— AIHNDLG UNITS <br />/ <br />BATHTUB <br />i <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />/ <br />KITCHEN SINK 6 DISP <br />I <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />! <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />i <br />I <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />j <br />PERMIT 3 <br />TOTAL FEE 5 <br />TOTAL FEE 5 <br />cno F1ccICc IIRF nMl V• <br />FRONT SETBACK <br />PEAR SETBACK <br />SwE Sf1BACK <br />PLANCHEI%�MBEy o/D <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VALANt SITE <br />FEES <br />I VALUATION <br />FEE <br />BUILDING <br />OYES ❑ NO <br />HEIGHT LIMITATION <br />wOF OW ulw <br />UNITS <br />SIZE OF KM71 <br />PLUMBING <br />OCCUPANCY NO OF STORES STORES <br />OCLOAD <br />BASENENi <br />MECHANICAL <br />GRWP <br />❑ ES ❑ NO <br />ADOIlwNA1PLAN CHECK <br />FIRE SPRIIPGEN REDO <br />REASON <br />OTHER <br />FWEAURMREOD <br />REASON <br />STATE BU0.MNG SURCHARGE <br />TYPE OF CONEY <br />Fw+SAPPROYEOBY <br />CITY OF EVERETT <br />PUBLIC WDPKS <br />LOCAL SALES <br />BATE <br />TAX CODE IS 3105 <br />TOTAL <br />