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APPLICATIG'A FOR CONSTRUMON PERMIT / <br />O[ <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • �59-8810 <br />DEMOLITION F7 COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWN <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE •� SUS �� `7 <br />�ysi�rr�A-iiBo'�8 <br />— � <br />TENANT <br />M 1LADDRESS <br />E1TY <br />ZI <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />%1l1 !'. FSC��bG <br />/F�a.✓C__��Y <br />r�lO� /ALSQ� <br />Oit'//9//�/�hT <br />S,ye,aeg� �« 1�nlAGp /° f? <br />/A <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />?�- <br />PHONE STATE UCENSE� <br />30\ � <br />13&1 56;C1 <br />PLUMBING CONTRACTOR MAIL ADDRESS �/ PHA/) STATE LICENSE <br />CITY ZIP s / - _ <br />uGA•ritir CvSTFM- Fl GAS I-1 ELECTRIC ❑ <br />DE: TIBE WORK AND S/OUARE FOOTAGE INVOLV <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND XNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />DESCRIPT ION OF PROPERTY (SHOWN BELOW OR AT TACH TWO COPIES) <br />LEGAL <br />LOT •� _3.. BLOCK of NY AL ./ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />OTHER <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WI4ICH <br />APPLICATION IS MADE AND I COMPL`,' WITH THE STATE <br />CONTRAC ORS LF`N I6.27 RCW AND 296.200 WAC. <br />X <br />PARCELTAX�I.y.NUMBER <br />- yO�e� <br />CONSTRUCTION LOAN LENDER. ADDRE55. TELEPHONE NUMBER <br />SIGI.' <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />A/C—A/HNDLG UNITS — H.P. <br />— <br />' <br />WATER CLOSET (TOILET) <br />' <br />FORCED AIR SYSTEMS—D.T.U. M E.A. <br />_ <br />BATHTUB <br />HEAT PUMP <br />— <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS — B.T.U. M <br />SHOWERATOR <br />CLOTHES DRYERS <br />T— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />R.^.NGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />; <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />SINK (SERVICE -- BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />I <br />I <br />I <br />SUB TOTAL S <br />i <br />SUB TOTAL 5 <br />PERMIT $ <br />' <br />PERMIT S I <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />USEZONE LOTAREA <br />HEIGHT LIMITATION NO OF OW'CLUNG <br />UNITS <br />OCCUPANCY NO. OF STORIES I OCCUPANT LOAD <br />SIDE SETBACK PLAN CHECK <br />VACANT SITE <br />FINES IT NO <br />BUILDING <br />SIZE OF BLDGRI, <br />PLUMBING <br />BASEMENT <br />MECHANICAL <br />❑YES ONO <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBUC WORKS <br />CITY OF EVER -TT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />FEE RECEIPT NO. <br />