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APPLICAT10h w <br />FOR CONSTRUCTLiN <br />PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 96201 •259-8810 <br />❑ DEMOLITION <br />❑ COMBINATION <br />)d BUILDING ❑M.E�C' IANICAL <br />El PLUMBING El SIGN <br />PROJECT ADDRESS: <br />,/Z-q 3�l' <br />/ �� 6-,c c r`; lV ti — <br />OWNER <br />MAILADORESS <br />CITY ZIP PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />AWJ111TECT OR DE� NER MAII ADDRESS <br />l�O/Is d?�Jfie, <br />CITY <br />71P <br />CA <br />PHONE (A <br />45971 S <br />l'0/1s�,2ucS/(1rY <br />.+'�-+ <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />21P <br />PHONE �� STATE LICENSE <br />MECHANICAL CONTRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />PHONE STATE LICENSE F <br />PLUMB14G CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />CONTRACT PRICE OF WORK ^ <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DESCRIBE WORK ANDOL�TAOE {NVOLyE(� /� <br />` <br />CONTACT PERSONAND ION <br />NOClf <br />7- <br />/J ,r " <br />i <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 />_ <br />PROPOSED USE OF BUILDING <br />(7Om - (- <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />—g <br />LEGAL DESCRIPTION OF PROPERTY(SHOWNBELOW OR ATT TWO COPIESI <br />eLor.K of — <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT_ _lJ� <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 WAC. <br />Jf�y, <br />X ] `+'J <br />PARE TAK 1.0. MIMBER ,_ A_ ©D� <br />NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE <br />SIGNAT E �- DATE <br />AA (�.Qs <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 T_ <br />_ <br />WATER CLOSET (WN) <br />A/C —AMNDLG UNITS <br />._ <br />BATHTUBFORCED <br />AIR SYSTEMS <br />_ <br />LAVATORY (WASH <br />HEAT PUMP <br />^_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 6 <br />CLOTHES DRYERS <br />DISHWASHERRANG=HOODLAUNDRY <br />TRAYWATER <br />HEATER <br />CLOTHES WASHE <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />_ <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE _ <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />' <br />' <br />EXHAUSTFAN <br />I <br />' <br />I <br />' <br />� <br />I <br />SUB TOTAL E <br />; <br />SUB TOTAL E <br />PERMIT E <br />I <br />PERMIT E <br />TOTAL FEE $ <br />' <br />TOTAL FEE E <br />�_ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />USEZONE IOT AREA <br />_ % <br />HEIGHT LIMITATION NO OF DWELLING <br />UNITS <br />STORES <br />EXt, Coac'. <br />DATE <br />SIDE SETBACK I PLAN <br />J/QOJ <br />VACANT SITE <br />DYES ❑ NO <br />FEES <br />BUILDING <br />SIZE OF BLDGfTI <br />A/^ <br />PLUMBING <br />MFCRANICAI. <br />- <br />BASEMENT <br />OYES ❑ NO <br />ADDITIONAL PLAN CNECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PLIBI Ir. WORKS <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />EEF RECEIPT NO <br />b D <br />(KJ <br />