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APPLICATII.N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 dE = T <br />DEMOLITION COMBINATION I RLIII DINE. ^ IUIPI'JAIMIrAI o1 uur w <br />SIG <br />PROJECT ADDRESS \ <br />LV+ER MAIL ADDRESS <br />rHv nn <br />UED M ALKPrt% I�1l5 N6Lk Ty—L VEL L C�IEV 77 blXcj�ZOL % 7 151 lS <br />TENANT <br />(J o oG ( MAIL ADDRESS CRY ZIP PHONE <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHnNF veTC . <br />CONTRACT PR3 OF WORK a 0 L <br />V <br />HEATING SYSTEM: f-IGAS 1 ELECTRIC <br />DE SCRIBEWORKANDSOUARE FOOTAGE INVOLVED <br />+ - - <br />CONTACT <br />PERSON AND ZONE NO <br />CD IL 2 <br />Cik2DC� !�I) A IVL��S <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 />CONTRACTORS LAW 1�8.27 R'CW AND 296.200 WAC. <br />SIGNATURE 00.7E <br />PROPOsEO D E OF BU!, - <br />1 1 T <br />I_L <br />LEG ALDESCRIP 01'PROPERTY(SHOWN BELOW OR ATTACH TWO COPIESi _ <br />Lor T tz LOCK �A� of C k S 1S LAr <br />PARCEL TAK I.D NUMBER <br />5G 'L4 — (P <br />CONSTRUCAOAVEGDER, ADDRESS. TELEPHONE NUMBER <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 />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />' <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />. <br />WATER HEATER <br />, <br />URINAL <br />' <br />WOOD Sl'OVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />; <br />FLOOR DRAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GASIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />, <br />' <br />GAS PIPING <br />EXHAUST FAN <br />; <br />I <br />, <br />I <br />I <br />, <br />, <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />I <br />PERMIT S <br />I <br />PERMIT S <br />, <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHFCj NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />AYES IT NO <br />BUILDING <br />I D <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGIT I. <br />PLUMBING <br />i <br />UNITS <br />OCCUPANCY <br />NO OF STORIES <br />OCCUPANTLOAD <br />BAS EMENT <br />GROUP <br />MECHANICAL <br />f]YES IT NO <br />ADDINONAL PLAN CHECK <br />I <br />I <br />FIRE ALARM AEG <br />REASON <br />OTHER <br />FIRE SPRINKLER REO'0 <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVER ETT <br />PUBLIC WORKS <br />i` <br />LOCAL SALES <br />TOTAL <br />1J3 1,S0 <br />DATE <br />TAX CODE IS 3105 <br />_ <br />