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APPLICATION FOR CONSTRUCTIC _J PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />17 DEMOLITION FI COMBINATION I-1 BUILDING Cl MECHANICAL FI PLUMBING fl SIGN <br />PROJECT ADDRESS %,� 7 A'CYJ!E/ <br />OWNER MNLADORESS CITY ZIP P ONE _ <br />SHa7COA) ELc�xx12%� 16.10 i�aG� 4tuc C%r/C2^FTT 3LG'/ <br />TENANT MAILADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MNLAODRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STAIE LICENSE <br />MECHANICAL CONTRACTOR MNLADDRESS CITY ZIP PHONE STATE LICENSE• <br />Fsi <br />PLUMBING CONTRACTOR MAIL ADDRESS CIT" ZIP PHONE STATE LICENSE <br />rRACCPRICE OFveowHEATING <br />SYSTEM: 0 GAS ❑ ELECTRIC n <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />I,J5 ALL_ 75� Cao 6-rd <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 1827 RCW AND 296200 WAC. <br />, 0� � —1 <br />X Lir JLN . �� � (/� <br />PROPOSED USE QF�yILDING <br />!�]rT��,ji`�' <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK DF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNAT E " DAT <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C — A/HNDLG UNITS — H.P. <br />' <br />BATHTUB <br />/ <br />FORCED AIR SYSTEMS — B.TU.7664PYE.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 6 DISP <br />; <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />I <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />) <br />GAS PIPING <br />EXHAUSTFAN <br />' <br />I <br />' <br />SUB TOTAL E <br />' <br />SUB TOTAL $ <br />' <br />PERMIT S <br />I <br />PERMIT S <br />777 <br />TOTAL FEE $ <br />' <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK I REAR SETBACK SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />nYE5 n NO <br />rcw <br />HUILDING <br />HEIGHT LIMITATION <br />NO(FDWELLING <br />UNITS <br />SIZE OF BLDG/T I. <br />PLUMBING <br />MECHYNICAL <br />OCCUPANCY <br />GROUP <br />NO OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />❑rEs n No <br />4^OITIONAL PLAN CHECK <br />FIRE ALARM REGO <br />REASON <br />LA <br />SPRINKLER REO'D REASON <br />IE BUILDING SURCHARGE <br />OF CONSL FANS APPROVED BY CITYOFEVERETT [.PUBLICWORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE I RECEIPT NO. <br />FEE <br />