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APPLICATIOd FOR CONSTRUCTmON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />001E77- <br />n DEMOLITION f 1 COMBINATION Mt BUILDING n MECHANICAL 1 PLUMBING 11 SIGN <br />PROJECT ADDRESS <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL AD' RESS <br />CITY <br />71P <br />PHONE <br />GE//{{JJERAL CONTRALTO MAIL AOORE55 <br />L CITY <br />�GJ <br />-/1PAJ� <br />PHONE <br />STATE LICENSE-Il <br />Le�sATE <br />MECHANICAL MAIL ADDRESS <br />CITY <br />771 <br />NE <br />LICENSE k <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PnIrj OF WORK <br />D G <br />HEATING SYSTEM: f l GAS r l ELECTRIC f"1 <br />DESCRIBE WORK AND SCUARF rOOTAG INVOLVED+ <br />N 64 <br />CONTACT PERSON AND 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 071 <br />NOT. " - GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTI, Y TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEH 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 C j]LY WITH THE STATE <br />CONT TORS LAW 1 7 R N 29 0 C. <br />X j <br />PROPOSED USE BUILDIN <br />y �A�� <br />-= <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF_ <br />3�= <br />PARCEL TAX I.D. NUMBER <br />3 y 2-/ 1 5 <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATUPE D <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM 1 <br />S FEE <br />WATER CLOSET(TOILET) <br />'J <br />_ <br />A/C—AMNDLG UNITS —H.P. <br />' <br />BATHTUB <br />p ; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />; <br />_ <br />DISHWASHER <br />I <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />—T <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />-`— <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />I <br />I <br />SUB TOTAL <br />$ <br />SUBTOTIL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />_ <br />' <br />FOR OFFICE USE ONLY: <br />PRONTSFTBACK REAR SETBACK <br />USE 70NE LOT AREq <br />HEIGHT LIMITATION <br />FIRE SPRINKLER RED <br />,FF or <br />SIDE SETBACK P' 4 NUMRFR FEP <br />VACANT SITE FEES <br />1I YFS 11 NO <br />NO OF DWELLING <br />UNITS <br />SIZE OF BLDGRI <br />BUILDING <br />PlI/M111NG <br />OCCUPANT LOAD <br />BASEMENT <br />IIYES II NO <br />MECHANICAL <br />RFASON <br />ADDITIONAL PLAN C 'ECK <br />O1HER <br />REASON <br />STATE BUILDING SURCHARGE <br />PLANS APPROVED BY <br />DAIS <br />CITY OF EVERETT <br />LOCAL SALES <br />. TAX CODE IS 3105 <br />PUBIIr, WORKS <br />TOTAL <br />RECEIPT NO <br />i <br />