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APPLICATIGA FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING E? MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: (33o M k,� � t (3\ V EI <br />1\wW Slvv�rt 133u M,AII;� rilra CVprt-ft TY.7-J zs9• S 1 Mb <br />DYIIIER MAIL ADORE SS CITY ZIP PHONE <br />TENANT <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />71P <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY )P P1404E STATE LICENSE <br />„I Fv 31a ISM$ (-rgl'il 71rIo1 ZSz-911R EvcS6s-Sl.ttk7 <br />.EC, CAL CONTRACTOR MAIUDORESS f.ITY LIP PIIONF SLATE LICENSE, <br />PLUMBING CONTRACTOR MAIL ADORE SS Gry LIP PHONE SLATE LICENSE <br />CONTRACT PRICE OF WORK <br />-0 3 Sy v <br />HEATING SYSTEM: &GAS ❑ ELECTRIC ❑ <br />OESCIBBE WORN AND SQUARE 10OTAGF. INVOLVED <br />011 fo 6�. Chan�r.f <br />CONTACT PFRSON AWyq PNONE NO <br />dot f';rElra if. is <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING Tr 'IS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIN3 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 10.27 RCW AND 296.200 WAC. <br />7 <br />X (�\A.,.-...T �C -IY' FiL <br />- <br />PROPOSE�]IUSE OF BUILDING <br />�mprim r1FE <br />LEGAL OESCWPTIpiW PROPERLY ISHOWN BELOW OR ATTACH TWOCOPIES) <br />LOT BLOCK or <br />PARCEL TAM I D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TFIEPHONE NUMBER <br />SIGNAT E 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 />I <br />ANC-AMNDLG UNITS <br />BATHTUB <br />( <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />SHOWER <br />1 <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />( <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL rIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />PACKFLOW PREVENTERS <br />_ <br />GAS RANGE <br />_ <br />SINK (SERVICE - BAR. ETC.) <br />GAS PIPING <br />_ <br />—�— <br />EXHAUST FAN <br />. <br />I <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />PEAR SETBACK <br />SIDE SETBACK <br />rIANCHCCK NUJMfl <br />FFF <br />RFC(IPt NO <br />J: <br />USE ZONE <br />IOF AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DING <br />MAIMING <br />—�— <br />DYES ONO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLUGRI <br />UNITS <br />PIIIMRING <br />OCCUPANCY <br />NO Of $-ORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MFCIIANICAI <br />GROUP <br />❑YES Ll NO <br />ADDITIONAL. PI ANCNFC.K <br />FIRE SPRINKLER REDO <br />REASON <br />OUTER <br />FIRE ALARM REDO <br />REASON <br />STAI E Run DING SI IRCIIARGE <br />TYPE OF CONST <br />PI ANS APPROVrD BY <br />CITY OF EVERETT <br />PIIflI1f. WORKS <br />— <br />- <br />LOCAL SALES <br />- <br />TAX CODE IS 3105 <br />TOTAL <br />DAIE <br />