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APPLICATIGA FOR CONSTRUCT_JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />762q LDWE2 Q;4e Q.k. PV611c t 98203 <br />OWNER MAIL AGORESS CITY ZIP PHONE <br />Ajar) f l7Dnna Amos 700 Lowrm PlieA EEVEtiER 9f7o3 3S_t- 3gi'o <br />TENANT MAILAODRESS CITY ZIP PHONE <br />ARCHITE/TOR DESIGNER MAILADDRESS CITY ZIP PHONE <br />Laaay 011Eli 564 33Y-2697 <br />GENERALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />q 700 .00 <br />HEATING SYSTEM: ❑ GAS 1R ELECTRIC Pr11P� i(at <br />DESC IBE WORK AND SOUARE FOOTAGE INVOLVED <br />' 0' <br />CONTACT PERSON AND PHONE NO. <br />Bul Dens 252-637 <br />fhg- ma <br />fF <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 i COMPLY WITH THE STATE <br />CONT ACTO 18.27 RCW AND 296.200 WAC. <br />X I-- <br />PROPOSED USE OF BUILDING <br />I EGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR A HTwoc pIE$ <br />LOT BLOCKE /Uu./JE�j��LL..�a� <br />_��� / <br />L' <br />PARCEL TAX LD. ^ _ - - <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNAT 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 FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />17,q 3 ; — <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />— <br />EXHAUST FAN <br />T <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />; <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />81DE SETBACK <br />PLAN CH KNUMBR <br />FEE (��Z� <br />RECEIPTNO.�/v <br />3 <br />ZO <br />`J�` <br />USE Zo <br />LOTAREA � <br />VACANT SITE <br />FE S <br />VALUATION <br />FEE <br />Z// <br />2srnu <br />❑YES `8N0 <br />BUILDING <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGR.I. <br />' <br />2SI <br />UNITS <br />ZU O <br />PLUMBING <br />OCCUPANCY NO. OF STORIES <br />OCCUPANTLOAD BASEMENT <br />MECHANICAL <br />I <br />GROUP <br />I <br />I <br />❑YES irt NO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RECID <br />REASON <br />OTHER <br />I <br />i <br />FIRE SPRINKLER REO'D <br />REASON <br />' <br />O <br />STATE BUILDING SURCHARGE <br />I <br />TYPE OF CONST <br />PLANSAPPROVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />— <br />LOCAL SALES <br />TOTAL <br />i <br />— <br />..SL—IJ <br />.J <br />DATE s 9s <br />TAX CODE IS 3105 <br />