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APPLICATIG- FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 0259.8610 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING J9 MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �i 9�D )a Ss Sf. !L <br />1I 11 �I/7n A _ 11 A::,, 11/.' cS17nl S 4'G <br />TENANT <br />MAII ADDRESS <br />CITY <br />TIP <br />I-HONI, <br />ARCHITECT OR DESIGNER <br />MAII ADDRESS <br />CITY <br />TIP <br />PHONE <br />GENERAL CONTRACTOR <br />[a S�a ,s/1 <br />a��tno <br />ES• <br />//MAILIADD✓1R <br />��/ •% J l -ll - <br />MAR ACORFSS <br />CITY <br />Alo,,, fd lie , <br />CITY <br />lll` — <br />)2r. rrva l7 <br />TIP <br />— PRONE <br />Asa all y-ssN.lt <br />PHONE <br />STATE LICENSE <br />STATE ULENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY TIP TNONE STATE LICENSE• <br />N .,O _ <br />CON TRACT PRICE OF WORK <br />HEATING SYSTEM: XGAS El ELECTRIC 0— <br />DESCRIBE WK AND SGUE FOOTAGE INVOLVED <br />CONTACT PERSOTI AND PHONE NO <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 />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCPoPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT _ BLOCK or _ <br />OTHER STAi E 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 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I D. NUMBER <br />NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. I ELEPIONE <br />X <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />'NDLG <br />UNITS <br />BATHTUB <br />;IR <br />SYSTEMS <br />)LAVATORY <br />(WASH BASIN) <br />IP <br />mns <br />'SHOWER <br />TERS <br />i_KITCHEN <br />SINK 8 DISP <br />; <br />DRYERS <br />'DISHWASHEROODLAUNDRY <br />TRAY <br />ATER <br />_T_ <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />1 <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE - BAR, ETC.) <br />GAS PIPING <br />- <br />) <br />EXHAUST FAN <br />I <br />I <br />SUB TOTAL S <br />_SUB TOTAL E <br />PERMIT S <br />�S <br />PERMIT S <br />TOTAL FEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: — <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />PLAN CIIECKNUMBER PEF RECEIPT NO <br />S&/ SS <br />USE ZONE <br />LOT AREA <br />VACANT 511E <br />❑YES ❑ NO <br />RUII DING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNIT.' <br />SIZE OF BIDGRI <br />PIHMRING <br />MECHANICAL <br />OCCUPANCY <br />NO III, SIDRES <br />OCCUPANT LOAD <br />BASFMENI <br />DROOP <br />❑vC5 ❑ NO <br />_ <br />AODI IIONPI. PI AN Cllf CN <br />FIRE SPRINKLER REO'D <br />nF ASON <br />DATER <br />FIRE ALARM REO'D <br />RF ASON <br />STATE OIOI DING SIIRCIMRGE <br />PART If WORKS <br />TYPE OF C,ONST <br />PLANS APPROVED RY <br />CITY OF EVERETT <br />LOCAL SALES <br />— <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />