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APPLICATIOd FOR CONSTRUCTION PERMIT <br />CITY OF ERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING IXMECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />OWNERIIIAII ADDRESS � . � 1^�. PHONE <br />15 � a �co ( CIS �J N�E� %2-0 I <br />ARCNITECT OiI DESIGNER MAH MDRF.SS CITY ----' 7 , <br />GENENAt GONTMCIOR MAIL ADDRESS [ <br />CITY <br />7K' <br />PHGNB <br />STATE LICENSE <br />tz�lo �V� 136 31 N )2 ( I <br />K Iy,� <br />I),+ <br />$y 3 <br />}� 4 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />PP <br />NiONL <br />STATE LICENSE IT <br />n. <br />PWMBING CONTRACTOR MAII AIXlBE55 <br />CITY <br />PHONE <br />STATE LICENSER <br />CONTIiAGT,'RICE OF WORK <br />— <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK All OUATRE FOOTAGE INVOLVED <br />CONTACT PrIISOII AND PHONE NO <br />606-wenook) <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 HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPII,,Ia1F0,T <br />COCONSTiADDRESS.UCTIOH <br />XSIG <br />PI SED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY ISIgwN BELOW OR ATTACH 7W0 COPIES) <br />LOT BLOCK _—_ or <br />_ <br />PARCEL TAX I.D. NUMBER <br />LDAN lENOER, A1E55. TELEPHONE NUMBEn <br />DATE <br />CITY BUSINESS I ICENSE NO <br />_PLUMBING <br />MECIIANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />T- <br />_ <br />_ <br />-A41NDLG UNITS <br />I <br />BATHTUB <br />; <br />_NC <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />, <br />SHOWER <br />_ _ <br />U141T HEATERS <br />I <br />_ <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />—�- <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER IIEATER <br />CLOTHES WASHER <br />I <br />WOOL) STOVE <br />, <br />URINAL <br />ME TAT. FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />; <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE i <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK(SERVICE - BAR, ETC.) <br />I <br />GAS PIPINGr- <br />EXHAUST FAN <br />' <br />I <br />, <br />SUB TOTAL <br />S <br />) <br />SUB TOTAL $ <br />I ' <br />PERMIT <br />f <br />, <br />PERMIT $ <br />-, <br />TOTAL FEE <br />S <br />' <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SFTBACK SIDE SETBACK rI AN CHGCJDNIINIIDT . rEF RECEIPT NO <br />USE70NE <br />LOTAREA <br />VACANT SITE <br />DYES D NO <br />FEES <br />OUILOIN, <br />HEIGHTLIMITATION <br />NO OF DWELLING <br />UNITS <br />SILE OF BLDGITI <br />------ <br />I•I IIMOING <br />OCC17PANCY <br />GROUP <br />I NO IN STI0ES <br />OCCUPANT LOAD <br />BASEMENT <br />DYES D NO <br />MECIIANICAI <br />------- <br />FIRE SPRINKLER REO'D <br />RFASON <br />ADUI I IONAI PI A11 CdI CK <br />OILIER --'---- <br />FIRE ALARM REO'D <br />REASON <br />_--- <br />STAIE DULL LUNG SI IHCI IAROE <br />%ArrnOVED UY CITYOFEVERETT Irum¢wnnes <br />LOCAL SALES .1----- - -- -- - - - - <br />TAX CODE IS ' 0r, TOTAL <br />