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APPLICATIGd FOR CONSTRUCI iON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-B810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: to 1 4 o C�- /[ 4-T I L4)A <br />Qf�c�/Ma , (olq Mp�n C+ ej,,fi L 7A 95�3 34S-SS10 <br />OWNER MAR ADDRES5 CITY ZIP PHONE <br />TENANT MAIL ADDRESS CITY ZIP PIIONE <br />T'l'PnS ...«T...7 20-I Oa4tr 1=.Ie,¢-ff L-�-74 <br />ARCHITECT OR DESIGNER AIL ADDRESS CITY 71P PHONF <br />GENERAL CONTRACTOR MAIUDORESS CI1Y LIP Pi -ONE SLATE LICENSE <br />CONTRACTOR MAIL ADDRESS CITY 21P PHONE STATE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEE <br />CONTRACT PRICE OF WOR <br />.f c HEATING SYSTEM: ❑GAS DIELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />a <br />3ys-ss1c) <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 />PROPOSERUSE OF BUILDING <br />1`G <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK OF <br />OTHI R STATE OR LOCAL LAW REGULATING COISTRUCTION OR THE <br />Sw -4G+zA 1 P_-A It <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />— q <br />bl <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAG. <br />PARCELTAXI NUMBS <br />o a� <br />X (�LJ ac.,, _ /0 - <br />TELEPHONE NUMBER <br />CONSTRUCTION LOAN LENC_R. ADDRESS. <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />r <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />-WC —AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK ISERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />i <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SE] <br />510E SETBACK <br />7 <br />44 <br />,,^ /, <br />U <br />S <br />USE ZD{N�J <br />1 <br />IOT AREA <br />VACANT SITE <br />NO <br />f `- <br />I&CITES <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGI I <br />2I <br />UNITS <br />kSr'�a <br />OCCUPANCY <br />GROVP <br />NO IK STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />❑YES <br />NG <br />FIRE SPRINKLER REO'D <br />REASON <br />RED D <br />OF P,DNST PLANS APPROVER By CITY OF EVERETT <br />LOCAL SALES <br />�- DATE TAX CODE IS 3105 <br />PIANCUECKNUMBER FEF I RECEIPT NO <br />�Z-Ic30 1 •3OJ 116) <br />BUILDING, <br />PI IIMIIING <br />/ V" <br />MECHANICAL <br />_ <br />3D IQL] <br />ADUI I IONAI PLAN CHOCK <br />I <br />I <br />GRRD <br />r <br />1 <br />STAIC BUILDING SIInCHARGE <br />Pun, If. wolf" <br />TOTAL <br />