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APPLICATILA FOR CONSTRUCT .JN PERMIT <br />�* <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 E 259-8810 <br />1 1 DEMOLITION i I COMBINATION 1 BUILDING 1,,�ECHANICAL 11 PLUMBING I I SIGN <br />(PROJECT ADDRESS <br />o R VAILADDRESS CITY ZIP PHo.r <br />TENANT MAR ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />MAIL <br />Cm <br />STATE LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS Cl7 ZIP PHONE STATE LICENSEE <br />7:1sy <br />- <br />CONTRACT PIRCE of WORK <br />HEATING SYSTEM: fl GAS I l ELECTRIC (l <br />DESCRIBE WORK AND SQUARE FE INVO VED <br />CONTACT PERSON AND PHONE NO. <br />r.,a.yr <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 />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY( SHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLACK of <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 I COMPLY WITH THE STATE <br />L�Lr� l,� �O �% <br />3 _00'r_ a0 <br />i ( <br />CONTRAC S LAW 18 RCW A 296 O WAC. <br />PARCEL TAX I.D. NUMBER <br />{/ <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />X DATE <br />.N JRE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET( TOILET) <br />A/C —A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />i <br />LAVATORY (WASH BASIN) <br />i- <br />HEAT PUMP <br />SHOWER <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 />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR. ETC) <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />' <br />I <br />I — <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />/ <br />TOTAL FEE $ <br />' <br />TOTAL FEE <br />I-UHi UH'H'HJC U= URLT: <br />FRONTSETRACK <br />REAR SETBACK <br />SIDE SETBACK <br />L, <br />RECEIPT NO. <br />VALUATION <br />FEE <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />rT YES rT NO <br />MBUILDING <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLDGITI. <br />UNITS <br />I <br />OCCUPANCY NO.OF STORES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />OYES ❑ NO <br />ADDITIONAL PLAN CHECK <br />i <br />-'-'- <br />FIRE ALARM RED <br />REASON <br />i <br />OTI/ER <br />' <br />FIRE SPRINKLER REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />I <br />PUBLIC WORKS <br />TYPE OF CONST <br />PIANSAPPROVLDIIY <br />CITY OF EVERETT <br />LOCAL SALES <br />TOTAL <br />%j �/L� <br />TAX CODE IS 3105 <br />DATE <br />