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APPLICATIC l FOR CONSTRUCT -M 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: 1,800 C�0_ j7 -,d Ae . <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />Valerie <br />e;e14 9gzrsl <br />Z5? -Iy8`I <br />TENANTC <br />MAtI ESS <br />CITY ZIP <br />PHONE <br />Jno 1 tLe <br />1--�ae1 <br />C>,- <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />' <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE STATE LICENSE - <br />MAIL ADDRESS <br />PHONE STATE LICENSE F <br />PLUMIING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE& <br />ca3 %-br; e <br />IUvr�l�inx % / <br />Z�el l�//!/. 01✓i a G$-C3")y�} 'P b(.3 <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: Cl GAS El ELECTRIC ❑ <br />DESCRIBE WORK AM SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />I HEPEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROVISIONS <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 18.27RCW AND 296.200 WAC. <br />X ✓"C;7 1'7 ��.ZT /- /— / <br />PROPOSED USE of BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK DF <br />PARCEL TAX ID. NUMBER <br />CONSTAUCION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSMESS 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 />' <br />A/C —A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />/ <br />LAVATORY (WASH BASIN) <br />% I` " <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />i ;b0 <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />7 <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />) <br />SINK (SERVICE — BAR, ETC.) <br />oiv <br />GAS PIPING <br />' <br />EXHAUST FAN <br />1 <br />SUB TOTAL S <br />SUB TOTAL $ <br />S� <br />PERMIT S <br />1 <br />PERMIT 5 <br />TOTALFEE $ <br />' <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REM SETBACK <br />SIDE SETBACK <br />PLAN CIIE.CK" <br />FEF <br />RECEIPT NO <br />�J! <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />—r— <br />BW101N6 <br />I <br />_ <br />LlYES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />' <br />UNITS <br />PLUMBING <br />I <br />OCCUPANCY <br />ND d SIOluFS <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />' <br />cnotm <br />❑YES ❑ NO <br />ADDITIONAL PLAN CIIf CK <br />FIRE SPRINKLER REO'D <br />REASON <br />omen <br />FIRE ALARM REGO <br />REASON <br />STAE BUILDING SIIOCIIAnOE <br />TYPE Or CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PLIBI If. WORKS <br />r <br />— `— <br />LOCAL SALES <br />--�— <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />m <br />