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APPLICATIOd FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT E BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 E 259.8810 <br />❑ DEMOUTION ❑, COMBINATION d BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />TENANT MAIL ADDRESS CITY TIP PHONE <br />PIKNIT STATE LICENSE <br />MECHANICAL CCNTRACTOR <br />MMLADDRESS <br />CITY <br />71P <br />PIIONE <br />STATE LICENSEE <br />PIgNE <br />STATE LICENSE <br />PLUMBING CCNTRACTOR <br />MAIL ADDRESS <br />CITY <br />III, <br />CONTRACT PRICE OF VIORK <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PEIISON AND PHONE NO <br />X R 7C 71 <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 AUTHORIZ :D BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />I`CO/NTRACTORSI nLAW 18.21 RCW AND 296.200 WAC. C <br />/y ATTIREIV. <br />T <br />PaoPosEDusE GF NG �,/ 1' , <br />JT <br />LEGAL DESCRIPTICIII OF n BELOW OR-IT-CNIYVOC Esl <br />LOT BLOCK a <br />►ARCEL TAX IO NUMBER <br />CONSTRUCTION LOIN LENDER. ADDRESS, TELEPHONE NUK49ER <br />CITY BUSINESS LICENSE NO <br />PLUMB!" <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 />NC—MiNDLG UNITS <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />_ <br />_ <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER TREATER <br />i <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />13ACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE - BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />EXHAUST FAN <br />� <br />I <br />SUB TOTAL <br />S <br />' <br />SUB TOTAL S <br />; <br />PERMIT <br />S <br />I <br />PERMIT S <br />' <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />cno ncclrc use nw v. <br />FRONT SETBACK <br />PEAn SETBACK <br />SIDE SETBACK <br />rI ANNCCI(I,ICCKK jimaatA rFF <br />AECfIPT NO <br />USE ZONE <br />tOT AREA <br />VACANT SITE <br />F E <br />VALUATION <br />FEE <br />BUILDING <br />2 i <br />OYES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />' <br />' <br />UNITS <br />PI IIMDING <br />OCNANCY <br />O <br />NODSICIAKS <br />OCCUPANT LOAD <br />BASEMENT <br />Mf f.11ANIU1 <br />❑YES ❑NG <br />--- <br />AGDIIONAI PI AN CIIT CK <br />FIRE SPRINKLERREO'D <br />RF AAON <br />1 <br />murn <br />FIRE ALARM REO'D <br />RFASM <br />____--- <br />STATE III n DINT. 511nC11Annt <br />TYPE or r,GNsr <br />PI ANS APrnoven By <br />CITY OF EVERETT <br />minw-WEKIKs <br />---' <br />LOCAL SALES <br />------ <br />— — <br />TAX CODE IS 3105 <br />TOTAL <br />_ - L <br />DATE <br />