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APPLICATION FOR CONSTRUCTWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET •EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION I I COMBINATION I I BUILDING UPCHANICAIL JI numur_ I I clr_.L <br />PROJECT ADDRESS 7 <br />OWNER MAIuoDREss Rom¢- CITY ZIP PHONE <br />C"l /7 M C)6 k>^ K "" <br />C✓✓er.,L-T 7- 96 I <br />S t 7 ,'1 "r v S <br />TENANT <br />MAIL ADDNFSS <br />CITY <br />71P <br />PIJONE <br />ARCHITECT OR DESIGNER <br />MAII ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />;Ir <br />PHONE <br />STATE LICENSE <br />PI ING CONTRACTOR <br />�JJ n t=w <br />MAIL. ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE Or WORK <br />HEATING RVgTFM- <br />I I aes <br />1 2 Wl POT019- n <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PFRSON' AND PHONE NO <br />�� U �l I iY'iD M1 LIi'1-D DI�(/.h�vY t .t�1 �Ct✓ <br />Ao('P,--X: ..' IT (`a- S of 5 v 1= i /K'7t1 JFW' fi� <br />111. <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 />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 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY Ti iE <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 />t� /7 <br />X <br />PROPOSED USE OFBunDING <br />A, e <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACHTWOCOPIESL <br />LOT _ BLOCK or <br />PARCEL TAX I D. NUMBER <br />CONSTRUCTION IOAN TENDER. DrwD <br />ADDRESS. TEL <br />SIGNATURE DAU <br />CITY BUSINESS I ICENSL NO <br />PLUMINNG <br />MECHANICAL <br />TYPE OF EOUIPMENT FEE <br />A/C- A(HNOLGUNIS—H.P. <br />_FORCE! I SYSTEMS — B.T.U. M EA <br />HEAT PUN J <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />I <br />BATHTUB <br />LAVATORY (WASH BASIN) <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 />_ <br />RANGE HOOD <br />' <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 />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />SUB TOTAL $ <br />CiJ <br />PERMIT $ <br />LI <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CITE .K NUMBER <br />FEE <br />RECEIPT NO <br />3i S <br />USE ZONE <br />IOTARFA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />HYFS fl NO <br />BUILDING <br />' <br />i <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />512E OF PLDGRI <br />i <br />RJIIS <br />PLUMBING <br />I <br />OCCUPANCY NO Of SIORLI <br />OCCUPANT LOAD <br />BASEMENT <br />i <br />I <br />MECHANICAL <br />FIVES 11 NO <br />AODI IONAI. PLAN CHLCK <br />-- <br />) <br />FIRE ALARM RED <br />HI ASON <br />OTHER <br />I <br />FIRE SPRINKIER RED <br />REASON <br />STATE BAIL DING SURCHARGE <br />J <br />i <br />I <br />TYPE. OF C.ONST <br />PI ANS APPROVE D BY <br />CITY OF EVERETT <br />PIIBVCWORKS <br />_ <br />I <br />LOCAL SALES <br />TOTAL <br />', <br />DATE <br />TAX CODE IS 3105 <br />