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APPLICATIO FOR CONSTRUC*DN PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT. WA 98201 •257.8810 <br />DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />M:HITCCT OR OESIGNLR MAIL ADDRESS CITY ZIP ARCANE <br />GENERALCONTRACTOR MAILADDRCSS CITY zP PHONE STATE LICENSE <br />MEGUNC,ALCONTRACTOR MALLADDRESS CITY zV PIw1E STATE LICENSE <br />P.VMBING Cp1iRAGlp1 MAIL ADDNE SS CITY zP PNCRE STATE LICENSE <br />Cg RUCT PACE OF NCRK <br />HEATING SYSTEM: I l GAS Il ELECTRIC ❑ <br />DESIRICRIBE Ww1K AND SQUARE FOOTAGE INNOLVE D <br />CONTACT PER" AND P A[NO <br />3 <br />/ <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 16.27 RCW AND 296.200 WAC. <br />X <br />PROPOSEDUSEa BuMUNNG <br />LEGAL DESCRIPTION OF PROPERTY (SHORAN BLLON CA ATTACH two 6OPICSI <br />LOT BLOCK a <br />PJICELTAK ID NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPIOINE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS ICCNSL N) <br />PLUMUING <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—A'HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />! <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />! <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC) <br />_ <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />SUD TOTAL <br />5 <br />SUBTOTAL S <br />_ <br />PERMIT <br />$ <br />PERMIT s <br />TOTAL FEE <br />5 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />Q - <br />FRONT SETBACK <br />REAR SETBACK <br />51DESE1BACK <br />PANCHECKWMBER <br />FEE <br />RECEIPT NO <br />USE za+E <br />LOT REA <br />vACANrsnE <br />❑YEs ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILwNO <br />REKNIT LIMITATION <br />NO OF DKEUING <br />UNITS <br />SIZE OF BLDGTI <br />PUMPING <br />OCCUPANCY <br />GROUP <br />ND DF s1Mf5 <br />OCCUPANT LOAD <br />BASEMENT <br />O IES T1 N0 <br />MECNANICA <br />I <br />AWNgN4 PLAN CIICCK <br />TIRE SPRINKLER AEG <br />REASON <br />OTTER <br />FIRE ALARM PEOD <br />REASON <br />STATE BUILDING suPENARCE <br />T, <br />) <br />TYPE OF CONST <br />PANS APPROVED BY <br />DAM <br />CITY OF EVERETT <br />LOCALSALES <br />Ti)CODE IS 0705 <br />PUBLK:WOAKS <br />TOTAL <br />