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APPLICATIOd FOR CONSTRUCTBJN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />DEMOLITION F1 COMBINATION ❑ BUILDING ❑ MECHANICAL 1-1 PLUMBING 11 SIGN <br />ADDRESS <br />l Vies r rf &-7- nk E( F-V,'C 7yi?lc 3 3-Cf 19-7ii 1 <br />OWNER MAILADDRESS CITY ZIP PHONE <br />kiln LoR/ CA►2LSoiy it II <br />TENANT MAILADDRESS CITY ZIP PHONE <br />MAIL ADDRESS <br />ur rnUnt slum wervx <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE♦ <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE If <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: 0 GAS R ELECTRIC ❑ _ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />/ /� <br />7� 777✓ <br />C66� <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 18.27 RCW AND 296.200 WAC. <br />" �' ` / Aw <br />seD usE of BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAK ID. NUM6ER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />+ <br />S GNR <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />1 <br />A/C—A/HNDLG UNITS — H.P. <br />1 <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK A DISP <br />) <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />1 <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />GAS PIPING <br />' <br />EXHAUST FAN <br />I <br />' <br />SUB TOTAL $ <br />) <br />SUB TOTAL $ <br />' <br />PERMIT S <br />I <br />PERMIT $ <br />1 <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGT I. <br />) <br />UNITS <br />PLUMBING <br />1 <br />OCCUPANCY <br />NO DSTOM11 <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />❑YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />1 <br />FIRE ALARM REO'D <br />REASON <br />OTHER <br />i <br />I <br />FIRE SPRINKLER REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />) <br />TYPE OF CONST. <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />