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APPLICATIt,N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • RDIVISION <br />3200 CEDAR STREET •EVERETT, EVERETT, WA <br />98201 • 259-8810 <br />f l DEMOLITION 1 COMBINATION I I BUILDING 11 MECHANICAL PLUMBING SIGN <br />PROJECT ADDRESS n✓� <br />OWNA MAIL ADDRESS •5 _ n Cm H 71P„ PHONE _ <br />A— <br />AH6IiRF.CT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />UTT ZIP PHONE STATE LICENSEr <br />LICENSE I <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: (]GAS FI ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PFRSON 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 1HIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN ORNOT. 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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE OF BUILDING -- <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR A1tAC11 TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX 1.0. NUMBER <br />CONSTI. UCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <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 FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />1 <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />KITCHEN FINK IS DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />1 ' <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />1 <br />_ <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />� <br />- <br />�s L <br />1 <br />i <br />SUB TOTAL $ <br />SUBTOTAL $ <br />� <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />FLAN CHECK NUM R <br />� <br />FEf <br />RECEIPT NO. <br />USF ZONE <br />LOTAREA <br />VACANTSITE <br />❑YES ❑ NO <br />FEES <br />I VALUATION <br />FEE <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING SIZE OF BLDG?I. <br />UNITS <br />PLUMBING <br />I <br />OCCUPANCY <br />GROUP <br />NO 01 STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />OYES TT NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM REO'0 <br />REASON <br />OTHER ( <br />—It <br />I �T <br />PIPE SPRINKLER RED <br />REASON <br />STATE BUILDIN SURCHARGE <br />I <br />TYPE 01 CONST <br />VE <br />PLANS APP OVEO BY <br />i J <br />DATE I° - ti. <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />T <br />I <br />TOTAL <br />- <br />(gyp I�7 <br />w1 <br />