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B'7 <br />APPLICATIC l FOR CONSTRUCT' )N 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: �{ g� O Cc AP.� _ A-'/C <br />TERANT v IINL ADDRESS CITY ZIP PIIONE <br />AACHITECT OR DESIGNER MAR ADDRESS P.ItY ZIP PHONF <br />GENERILL CONTRACTOR MAIL ADDRESS (:111 ---- ZIP — PIIDNF STATE I ICENSE F <br />CONTRACT PRICE OF WOW <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AM SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON ANO PHONE NO <br />CrAS PFPnL)ts- i=0� /foT u)AiE2�_ <br />— <br />/{C'7ITEk.. � Fi2EPts+cc_ z".�SeIe.T <br />I HEREBY CERTIFY THAT 1 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 />OF BUILDING <br />PNOPMO USE <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />PEaPEREY (SHOWN BELOW OR AT EACH TWO COPILSI <br />LEGALDESC/BPT'ONOF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />Lot BLOCKof <br />_ <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRICTION. 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 />-- <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />_ _ C <br />CONSTRUCTION LONE LENDER. ADDRESS. TELEPHONE NUMBER <br />X DALE <br />SM+NAT <br />CITY SINESS LICENSE NO <br />PLUmewQ <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />-.. FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER (CLOSET (TOILET) <br />A/C — AMNDLG UNITS <br />FORCED AIR SYSTEMS <br />BATHTUB <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />SINK 8 DIS 3 <br />CLOTHES DRYERS <br />' <br />- <br />KITCHEN <br />DISHWASHER <br />_; <br />, <br />HANGEHOOD <br />C <br />WATER HEATER <br />' <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WOOD STOVE <br />1 <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />' <br />/ <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />IACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />N <br />—_� <br />GAS PIPING <br />EXHAUST FAN <br />1 <br />1 <br />SUB TOTAL f i <br />SUB TOTAL f <br />i <br />PERMIT f <br />PERMIT f <br />' <br />-- TOTAL FEE f <br />TOTAL FEE f <br />' <br />140 FOR OFFICE USE ONLY: - IKamiNONo <br />PI AN CIIECK NUMRFn FIE <br />FRONT :,ETRACK REAR SETBACK SIDE SEIBAP.k <br />VALUATION <br />USE ZONE LOTAREA VACANT SITE <br />EES <br />DYES L7 NO n1111111N6 <br />NEIGIIT LIMITATION NO OF DWELLING SIZE OF RI IK:nI "------ -� -- --_- — <br />UNITS PI I)MRING <br />OCCUPANCY NO PE SIPRES OCCUPANT LOAD BASEMENT MECHANIC.AI. <br />GROUP (I Is ❑ NO —.-- _ <br />-- ADDIIIONAI. PLAN CHECK <br />FIRE SPRINKLFA RE(Q) RF ASON-- <br />OTHER — <br />FIRE ALARM NEO'D REASON <br />STATE Rl➢IDIHG SURCHARGE <br />TYPE <br />Dr E•.oesT PIANcnrrnovm ev CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />