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APPLICATItoN FOR CONSTRUCT TON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3,)00 CEDAR STREET A EVERETT, WA 98201 • 259-8810 4wry <br />❑ DEMOLITION ❑ COMBINATION ©' BUILDING ElMECHANICAL ElPLUMBING ❑ SIGN <br />PROJECT ADDRESS: I IBI,')(Q VIP-61f /A AvG <br />r03EE'— Lw�5Y4v 19oi- VIa(.' I'A Aye Evcrc� Lcm 99zol <br />OWNER MAL ADORESB CITY TIP PHONE <br />MAIL <br />CITY lip <br />�AGTANGIIIILCI pN DESIGNER MAII AIIIINESS CITY DIP PIIONF <br />GAS -mac bib LAuarL AZ (Sgeacwr LTA 9fc 20 I L 2f ZS4-/3)/— <br />GENFBAL CONTRACTOR MAIL ADDRESS CITY )II` PHONE STATE IICrN5E1 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />— 26z: G). 04;'1I A <br />CONTRACT PRICE OF WORK <br />�— <br />HEATING S S EM: ❑GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORN ANO SQUARE FOOUGE INVOIVEp <br />u a-' <br />CONTACT PERSON AND PIIONF NO <br />1=D C)LS0n1 ZS`1-1.3 <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 WAG, <br />PROPOSED USE oP BUILDING <br />C�A4� <br />LEGALDESCRIPTION OF PROPERTY (SHOWN BELOWORATTACH TWOCOPIES) <br />LOT BLOCK or <br />PARCEL TAK 10. NUMBER 3' YY 33!7 �T !� <br />^ U <br />CONSTRUCTION LOAN IENDEIi.ADDRF55. TELEPHONE N4BCIlD <br />SIGNATURE DATE <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 —A/HNDLG UNITS <br />T— <br />BATHTUB <br />_ <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK d DISP <br />i <br />CLOTHES DRIVERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUIJTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />_ <br />BACKFLOW PREVENTERS <br />GASRANGE <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />�— <br />EXHAUST FAN <br />SUB TOTAL S1 <br />SUB TOTAL E <br />_ <br />PERMIT g <br />PERMIT E <br />TOTALFEE E <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: (%y 5) <br />FRONT SETBACK <br />'., <br />I�EJ <br />REAR SFTRACt <br />/ <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />J JAL/l/ <br />FCF <br />OVALUATION <br />RECEIPT NO <br />USE ZONE <br />— Z• <br />IOTARrA <br />VACANT SITE <br />OYES ❑ NO <br />OYES NO <br />FEES <br />FEE <br />RIIIIDING <br />BIIIIDMG <br />IO� <br />/�I�n <br />C <br />HEIGHT LIMITATION ^ <br />!J� <br />NO OF DWELLING <br />UNITS <br />SZL OF BIDiRI <br />S e. <br />r <br />PLUMBING <br />I <br />OCCUPANCY <br />v-/ <br />NO ND N STORIES <br />/ <br />OCCUPANT LOAD <br />BASEMENT <br />OYES 6<1 <br />MFCHANICAI <br />ADDITIONAL. PLANCEFCK <br />FIRE SPRIIIKLER RED D <br />FIRE ALARM REGD <br />BEASON <br />REASON <br />OTHER <br />STATE BIIIt DING SURCHARGE <br />rugnc wonKS <br />!l <br />� — <br />TYPI. OF Coast <br />/ <br />PLANS APPROVED BY <br />nA.E6� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL .__ —_ <br />__. — <br />/ �— <br />__. -- �D `--,:66 <br />