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APPLICATIOd FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT - BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 - 259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ EI,ISI.DING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ,-J L ► t Sc4k, A t ll ril- c- il�i � 20 j <br />OWNER MAILADORESS <br />CITY <br />Tlr <br />PHONE <br />BLILkG�tc,�� Ltsi ► <br />-fir xr <br />r� AJ <br />i <br />LL�,� L t Zz -�f ]c-I <br />TIE LINT u ILADOTIESS <br />ARCHITECT-ORDESIGNER MAIL ADDRESS <br />my <br />CITY <br />11P <br />TB` <br />PHONE <br />PHONE <br />Mnll ADURE 55 CITY <br />2rre z(4eo <br />MAIL ADDRESS CITY <br />PLUMBING CONTRACTOR MAILADDRESS <br />Tmn PHONE _ STATELICENSE- <br />ZIP <br />STATE LICENSE I <br />CITY ZIP PHONE STATE LICENSE - <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: 10 GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />1 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 CONSTRUC'ION 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 )S - ADE A D I COMPLY WITH THE STATE <br />CONTRACT RS LA 11! 7 AC AND 296.200 WAG. <br />X <br />- <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACII TWO COPIES) <br />LOT _ _ BLOCK _ Or <br />PARCEL TAX I.D. NUMBER �� F� /� <br />X »S <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATL11 CLOSET (TOILET) <br />A/C —AMNDLG UNITS <br />T <br />BATHTUB <br />FORCED AIR SYSTEMS <br />-T <br />LAVATORY (WASH BASIN) <br />HEAT PUF.'P <br />_ <br />SHOWER <br />UNIT HEATERS <br />' <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />( <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />i <br />1 <br />T— <br />SUB TOTAL S <br />SUB TOTAL f <br />_ <br />PERMIT S <br />PERMIT f <br />TOTAL FEE f <br />TOTALFEE S <br />FOR OFFICE USE ONLY - <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFn <br />rLF <br />RECFIrT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />nWL01NG <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLOGRI <br />+— <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />NOD SIOMIS <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />GROUP <br />_ <br />❑YES ❑ NO <br />ADDIIIONAL PUN CHECK <br />FIRE SPRINKLEn REO'D <br />REASON <br />DH¢n <br />FIRE ALARM RED <br />REASON <br />SI,E III, DING SUnCI1ARGE <br />TYPE OF rONST <br />PI ANS APPROVE D BY <br />CITY OF EVERETT <br />runur, wonKs <br />--"-- — <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />