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APPLICATIC J FOR CONSTRUCT )N PERMIT <br />CITY OF ERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: Zcr 30 jRnLlc N� <br />9N'NER � MAIL ^V ESS CITY TIP 1 PHONE <br />I,r ,\zcs�YiLeI�\ucilaeetl 29�t�l�fctcect1_u=' 4vc�vcr�cll0a�1a2blIZS`�-713i <br />TENANT MNLADORE.S ! CITY 71P PHONE <br />1`\�11Tf•t V c <br />I'�. 1� 9 <br />71P PHONE <br />tuvE,�c�i�-i8zoc <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />71P PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSER <br />I, <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />GE <br />DESCRIBE "AND SQ A FOOTAINVOLVED <br />\I <br />CONTACT PERSON AND PHONE NO <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 18.27 RCW AND 296.200 WAC. <br />X 4� /�)�1JCjAM7"� �/ • �� ,P J V q �A A / C _U' / / l7 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO CON <br />LOT BLOCK OF <br />PARCEL TAXI D. NUMBER n <br />y.39/ <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNATURE GATE ' <br />CITY BUSINESS LICENSE NO <br />PLUMBING <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—AtHNDLG UNITS <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />1 <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />, <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />GAS PIPING <br />EXHAUST FAN <br />' <br />1 <br />, <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />; <br />PERMIT <br />S <br />, <br />PERMIT S <br />1 <br />TOTAL FEE <br />S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK <br />FEF <br />RECEIPT NO <br />/N�UMBFn <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑ NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />UNITS <br />PUIMBING <br />OCCUPANCY <br />NO DE IILVULS <br />OCCUPANT LOAD <br />BASEMENT <br />—T— <br />GROUP <br />I <br />MECHANICAL <br />DYES ❑ NO <br />ADDITIONAL PLAN CnFCK <br />, <br />FIRE SPRINKLER REU'0 <br />PEASON <br />0114ER <br />FIRE ALARM RED <br />REASON <br />STATE BUILDING SURCHARGE <br />rum Ic wonKc <br />( / <br />TYPE of ror+sT <br />PI nNs APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TOTAL <br />—— <br />tij� <br />TAX TAX CODE IS 3105 <br />DATE <br />( <br />