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APPLICATICA FOR CONSTRUCI'.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 •259.8810 <br />❑ DEMOLITION <br />COMBINATION <br />C�� <br />❑ BUILDING ❑ MECHANICAL Cl PLUMBING n SIGN <br />CONI RACT PRIG <br />_ <br />HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PE Nd <br />c —o�lY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE RUE 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 />PERFORMOTHER ANCE OF CONSTRUCTION. THAT II AM ATE OR LOCAL LAW REGULATING 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 RC AND 290.200 WACCC. <br />4/ <br />f '" <br />PR VSEO USE OF BUKpNG <br />LEGAL OEscRIP aPROPERTY ISLUORM BELOW OR ArtAtN TVK/COP1Es1 <br />LOTM_ BLOCK OF <br />r r I <br />G J <br />L E R( d <br />PNLCEL TAX I.D. NUMKR <br />' <br />CONSTPIICl10N LENDER. ADDRESS. 1ElEPNONE MAMER <br />DATE <br />SKi11Ai11RE o 'aft <br />CITY BUSINESS LICENSE NO. <br />PLUM1100 D <br />MECHANICAL IV b H 051 <br />NO. <br />I TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />I TYPE OF EOINPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />MMDLG UNITS <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />, <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />, <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />; <br />IlOOR DRAIN <br />GAS FIREPLACE <br />, <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />, <br />' <br />EXHAUST FAN <br />, <br />I <br />, <br />I <br />, <br />SUB TOTAL $ <br />SUB TOTAL f <br />' <br />PERMIT f <br />I <br />PERMIT f <br />, <br />TOTAL FEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />EEF <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ❑ NO <br />BUILDINGi <br />HEIGHTLIMITATIONNO <br />OF DWELLING <br />SIZE OF BIDp?I <br />, <br />UNITS <br />PLUMBING <br />I ' <br />OCCUPANCY <br />NO OF SIORES <br />OCCUPANT LOAD <br />BASEMENT <br />i <br />GROUP <br />I <br />MECHANICAL <br />, <br />❑YES ❑ NO <br />ADDITIONAL PLAN CNF.CK <br />i <br />FIRE SPRNKIER REG'D <br />REASON <br />OTHER <br />i <br />' <br />FIRE ALARM REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PLANSAPPROVEDbY <br />CRY OF EVERETT <br />PIIBI IC WORKS <br />' <br />LOCAL SALES <br />�— <br />TOTAL <br />— <br />DATE <br />TAX CODE IS 3105 <br />