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APPLICATIOd FOR CONSTRUC'T.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVQION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />n DEMOLITION I1 COMBINATION [A BUILDING I 1 MECHANICAL ;'LUMBING I I SIGN <br />PROJECT ADDRESS 3 4/ 7 w QTM D Fr- <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />BgIA/j <br />-L,)(\by1AlZ <br />7/y <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADIMESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICFNSF A <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE N <br />PLUMBING CONTE ACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE. <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: I I GAS I l ELECTRIC I I <br />DESCRIBE WORK ANO IOU F. FOO- GE INVOLVED <br />Cl C % <br />CONI.bi PFRSON ANO PHONE NO <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 C i <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 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 18.27 RCW AND 296.200 WgAC. <br />PROPOSED USE OF BUILDING / <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR A77ACH TWO COPIES) <br />107 BLOCK OF <br />PARCEL TAX I D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />CITY BUSINESS LICENSE NO <br />PLUMMNO <br />MECHANICAL _ <br />NO. TYPE OF EOUIPMENT 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 />BATHTUB <br />FORCED AIR SYSTEMS - B.TU. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />1 <br />_ <br />HEAT PUMP <br />T- <br />SHOWER <br />UNIT HEATERS - B.T.U. M <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />T <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />GAS RANGE <br />_- <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />i <br />SUBTOTAL $ <br />SUBTOTAL $ <br />' <br />_T— <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />PLUMBIN <br />_ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />EEE <br />RFCRPT NO <br />USE ZONE <br />I OT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />r)YES II NO <br />BUILDING <br />5 <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SRF Of BL1MR I <br />❑NIT$ <br />G <br />OCCUPANT LOAD <br />BASEMENT <br />AYES I I NO <br />MECHANICAL. <br />REASON <br />AnDI110N/A. PI AN CHECK <br />OTHER <br />DEACON <br />STATE BUILDING SUnCHAnGE <br />PIANSAPpnovennY <br />,.... <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PURI IC W011K9 <br />TOTAL <br />N <br />