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APPLICATILA FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 25F-8810 <br />Fl DEMOLITION n COMBINATION fl BUILDING IX, MECHANICAL I PLUMBING I I SIGN <br />PROJECT ADDRESS 3 2 c 3 Ct GEC% <br />)WNER MAIL ADDRESS CITY ZIP PHONE <br />:UOH)O y%On/DdOA� 4622 S 31 fiiv (-L)eLtil' 99Z06 ZSZ Li <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNED MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />(LUCoPA celiz 1 /Nc 229/c eit GJ F,O-o&).Qf 9(1226 ))�- -)`fxF LUFOP�L/ir>Qn� <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />T o <br />HEATING SYSTEM: V(GAS Fl ELECTRIC Fl <br />DESCRIBE MONK AI DUARE FOOTAGE INVOLVED <br />Ily c TAT c cotes q-cv n�cTwy� �� �snln <br />CONTACT PERSON AND PHONE NO <br />IY T GJ c <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 />CONTR TORS LAW 18.27=WAND296.200 WAO.qCONSTRUCTION <br />X I /J/�Ltiev// l ' S <br />SIGNATURE DATE <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY( SHOWN BELOW OR ATTACH TWO COrIES) <br />LOT BLOCK Or <br />PARCEL TAX I D. NUMBER <br />LOAN LENDER, ADDRESS. TELEPHONE NUMBER <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 />' <br />A/C —A/HNDLG UNITS — H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />—LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />T <br />_ <br />CLOTHES WASHER <br />/ <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />_ <br />MC7AL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC_.) <br />GAS RANGE <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT S <br />I <br />PERMIT $ <br />' <br />TOTALFEE $ <br />' <br />TOTAL FEE S <br />' <br />rno ncchrr nee nNL v <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECKr NU a IT <br />FEE <br />RECEIPT NO, <br />C� <br />pEES I <br />VALUATION <br />FEE <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />DUILC?IG <br />i <br />AYES ❑ NO <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGfTI <br />UNITS <br />PLUMBING <br />MECHANICAL <br />i <br />OCCUPANCY NO OF STORIES <br />OCCUPANTLOAD BASEMENT <br />GROUP <br />I <br />❑YESITNO <br />ADDITIONAL PLAN CHECK <br />I <br />FIRE ALARM RED <br />REASON <br />I <br />OTHER <br />FIRE SPRINKLER RED D <br />REASON <br />i <br />STATE BUILDING SURCHARC' <br />' <br />' <br />PUBLIC WORKS <br />TYFE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />; <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />