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APPLICATION,d FOR CONSTRUCTWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION ou <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />OWNER MAIL ADDRESS CITY 21P PHONE <br />LYRE E i341NK j�oROXaa6 wI�ver�J� ��ao3 c?oG 3�s"�7as <br />TENANT MAILADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY <br />21P <br />PHONE <br />pi�y/d as C rev <br />7^ C�� <br />J <br />G.E!NE.R,ALOR <br />MAILADDRESS <br />CItt <br />ZIP <br />PHONE <br />STATE LICENSE L <br />_CONTRAG <br />�+nJ A% <br />murher- <br />MEcCHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSES <br />/1!!; <br />m G4w I9t`— <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE( <br /><',I.r iFe <br />i "n a I+ <br />CONTRACT PRICE OF WORK - ` <br />>12L/& <br />HEATING SYSTEM: ❑GAS {ELECTRIC ❑ <br />DESCRIBE EWOfiN 13 SOUAREFO0TAGE INVOLVED <br />CONTACT PEPSON� IIjyJ2; � -�r�� <br />C% <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 />PROPOSE�U BUILDING <br />S• <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 COF IE ) <br />LOT BLOCK oP <br />-� �f <br />AUTHORITY TO VIOLATE 'JR 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 CF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />—' <br />• <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO S LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />X <br />COy$`T N LOAfI�E PEBS. TELE'PHONs <br />A E n i� DATE <br />C_ �✓K � 7/ J <br />%G <br />CITY BUSINESS LICENSof E NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—A/HNDLG UNITS — H.P. <br />' <br />Z. <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERS—B.T.U. M <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />I <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />; <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />' <br />I <br />1 <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />' <br />TOTALFEE <br />S <br />' <br />TOTALFEE $ <br />' <br />FRONT SETBACK <br />REAR SE'BPCK <br />SIDE SETBACK <br />PLAN CHECK NU BFR FEE <br />RECEIPT NO. <br />o' <br />/ C) <br />5 <br />-:) <br />USE ZONE <br />LOTAREA <br />VACANj41TE <br />EES <br />VALUATION <br />FEE <br />BUILDING <br />6/f 7 3 <br />t T 2 2 1 <br />,(`.I YES ❑ NO <br />HEIGHT LIMITATION <br />NO, OF DWELLING <br />UNITS I <br />SIZE OF BLDG41. <br />/Tso .if Ln/"(. f <br />PLUMBING <br />Z <br />W <br />OF STORES <br />OCCUPANT LOAD BASEMENT <br />OCCUPANCY <br />GROUP <br />3 <br />I NO, <br />I <br />/O <br />a ❑YES GN <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />/ <br />FIRE ALARM RED <br />REASON <br />V <br />OTHER <br />FIRE SPRINKLER RED <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />- <br />TYPE OF CONST <br />PLANSAPPR VEDBY <br />CITY OF EVERETT <br />!`'��, <br />LOCAL SALES <br />r— <br />Y-N <br />Z , 5 <br />TAX CODE IS 3105 <br />TOTAL <br />DATE y / <br />