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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />n DEMOLITION COMBINATION fl BUILDING Cl MECHANICAL Il PLUMBING Fl SIGN <br />PROJECT ADDRESS <br />5 kl sr. `.a UJ, <br />OWNER MAIL ADDRESS ntv ....... <br />(-_ <br />, zi-04 <br />dl <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAILADbRESS <br />GENERAL MAILADDRESS <br />CITY <br />21P <br />PHONE STATE LICENSED <br />RETCU <br />_�CC_1ONTRACTOR <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CUT'/ <br />C�-/ ' <br />14 LLOE <br />ZIP <br />PHONE <br />5l <br />STATE III <br />PLUMBIN@ CONTRACTOR ADDRESS <br />(, �' n-.-,,)I , I J- <br />L,IY <br />ZIP <br />PNONE <br />STATE LICENSER <br />11 <br />CONTRACTP OFWDRK <br />�f <br />HEATING SYSTEM: 'XI GAS n ELECTRIC fl <br />DESCRIBE WORK AN S UARE FOOjjbE INVOLVED <br />C 7ACT PERSO D PHON <br />_ <br />N ,, <br />0T) Co <br />r f I <br />I [ <br />-0 <br />I HEREBY'CERTIFY'THAT I HAVE READ AND 'EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />sEo u E of B Lallo <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />y lQ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY TO VIOLATE OR, CANCEL THE PROVISION OF ANY <br />L <br />a <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />, PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED,BY THE <br />T <br />OWNER TOyyWHICH <br />PI FORMEWI <br />( <br />,,Q L, <br />HRKT ER STATE <br />A PLICATTIIONHI SP MADE AND COMPLY <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />y I/ .4 • l� <br />PARCEL TAX I.D. NUMBER ] <br />_— VI-70 c)( W - o0o6 <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />X <br />SIGNATURE <br />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 />' <br />A/C—A/HNDLGUNITS—H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS — B.T.II. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERC — B.T.U. M <br />, <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />, <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />, <br />URINAL <br />' <br />WOOD STOVE <br />, <br />DRINKING FOUNTAIN <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />—�— <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING,) <br />, <br />BACKFLOW PREVENTERS <br />i <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />1 <br />GAS RANGE <br />, <br />I <br />' <br />GAS PIPING <br />1 <br />j <br />)' <br />1 <br />EXHAUST FAN <br />, <br />1 <br />� <br />1 <br />� <br />1 <br />� <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />, <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />4 <br />TOTAL FEE $ <br />; <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK _ <br />SETBACK <br />!-C% <br />SIDE SETBACK <br />3� / <br />PLAN CLI(C% rvCM9ER <br />FEE <br />RECEIPT NO. <br />FRREAR <br />%� <br />USEZONE9 <br />AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />/"� <br />(IYES it NO <br />BUILDING <br />7 <br />d (] <br />HEIGHT LIMITATION <br />NO <br />OF DWELUNR. <br />SIZE OF 8 1. <br />PLUMBING <br />i v <br />7-0 <br />UNITS <br />1L FI <br />1 L VAA1Ci -I' <br />..A33??SEMENT <br />OCCUPANCY <br />GHWP <br />Iq OE SfppIES <br />OCCUPANT LOAD <br />0 <br />MECHANICAL <br />, <br />2 <br />fI YES � <br />CX/ <br />ADDITIONAL PLAN CHECK <br />FIRE RE ALARM REO'D <br />RF ASON <br />OTHER <br />T <br />I <br />FIRE SPRINKLER REO'R <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />1 YPE OF CONSi <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />