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APPLICATWN FOR CONSTRUC'ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING it MECHANICAL O PLUMBING ❑ SIGN <br />4% <br />CONTRACT PRICE OF WORK <br />(,� C' o <br />HEATING SYSTEM: ❑ GAS il ELECTRIC ❑ <br />DESCRIBE WORK AND MAPS FOOTAGE AVOLYEO <br />CONTACT PERSON AND PHONE NO <br />Y P/-k <br />PROPOSED USE a BUILDING <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 />CONTR /y//'S'//yJ/qW 18 27 RCCW//A/ D 296.200 WAC. <br />X +v f�i/L�� //lLZ� <br />LEGAL OESgAPTION OF PROPERTY ISHOVIN BELOWOR ATTACH TWOCOPIES) <br />LOT A54 1L&OCK �V/) GF - <br />3 y� i n�,� 9V� <br />Co -,y 19 A ox ZY4 <br />PARCELTAA I D NUMBER <br />CONSTRUCTION LOAN UNDER ADDRESS, TELEPHONE NEWER <br />BONAT R Jar I DiAT <br />CITY BW WESS 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 />A/C—AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH S4SIN) <br />HEAT PUMP <br />—~-- <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK B OISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE. <br />URINAL <br />METAL FIREPLACE (WOOD BL IRNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />_ <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />E <br />SUBTOTAL E <br />PERMIT <br />E <br />PERMIT E <br />TOTAL FEE <br />E <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBE��R <br />FfE <br />RECEIPT NO <br />USE ZONE <br />OtAMA <br />VACANT SITE <br />OYES 0 NO <br />FEES - <br />VALUATION <br />FEE <br />BULGING <br />—� <br />HEONTLIMITAICH <br />NO CF KNELLING <br />UNITS <br />BIZEDF&CHIT <br />P U401N <br />OCW <br />GRgTP HC <br />WOT STOP45 <br />OCCUPANT TOAD <br />BASEUENT <br />❑YES ❑ NO <br />YECNANCAL <br />ADpI1ONAL PLAN CHECK <br />EBVE SPRINKLER RED <br />REASON <br />OTHER <br />FIRE ALARM MOD <br />REASON <br />STATE BEADKIO SURCHARGE <br />TYPE wcONST. <br />PUNS APPROVED e\ <br />OAIE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC wrnKS <br />TOTAL <br />