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APPLICATIC"i FOR CONSTRUCT,JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 71P PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />6q / STATE LICENSE I <br />/%,"�;LeiV, <br />7 0� <br />i✓ is <br />. �) i�iz � <br />5y i c c F �&27U <br />MECHANICAL CONTRACTOR <br />MAILADDRESSS <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE F <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC _ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVE <br />CONTACT PLRSON AND PHONE NO <br />7K{�blL-N=f�jJA4. ,F v /�tC/L�E.Y <br />si <br />IYIiTiiS. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROVISIONS <br />PROPOSED USE of BUILDING <br />3 <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SLawNBELOW ORATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK OF <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF C -'JSTRUCT;ON. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAD.0 AND I COMPLY WITH THE STATE <br />CONTRACT RS W 18. 7 RC//W AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />X - Aw C6 7`- �.� <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATU GATE Y <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—AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 6 DISP <br />) <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOED <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />------------ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) ! <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />" <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />_ <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />' <br />' <br />EXHAUST FAN <br />1 <br />I <br />I <br />1 <br />' <br />I <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT S <br />I <br />PERMIT £ <br />' <br />TOTALFEE S <br />It <br />TOTALFEE S <br />' <br />rw" wrrly� <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑ NO <br />BURDING <br />i <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLOWN <br />' <br />UNITS <br />PLUMBING <br />' <br />T <br />MECHANICAL <br />OCCUPAW:Y <br />NO OE SIOPoES <br />OCCUPANTLOAD <br />BASEMENT <br />GROUP <br />DYES ❑ NO <br />ADDITIONAL PI AN CHECK <br />I <br />�— <br />FIRE SPRINKLER REO'D <br />REASON <br />OTHER <br />FIRE ALARM IIEOD <br />REASON <br />' <br />STATE BUILDING SURCHARGE <br />' <br />PIIRI IC WORKS <br />—J— <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />onrE <br />