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APPLICATI(. _] FOR CONSTRUCT _IN <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, `WAA 98201 •259-8810 <br />❑ DEMOLITION 0 COMBINATION PJ/ ❑ BUILDING MECHANICAL <br />PROJECT ADDRESS: /dy /99 " Aj s/' <br />,m^ ay ., Jty" <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />PERNAIT <br />�* <br />PLUMBING ❑ SIGN <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />�%1dv><f �l cD11J�Co C3/1 a lG .8o T,FXe7/1r i<:9L/ T/.1��n�.r Io,� 9i'S� 99 �� 3'Z`j � <br />GENERAI,CONTRACTOR MAILADDILESS CITY / ZIP PHONE STATE LICENSEE <br />/ C`/LItl C P D S- /3 <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSEE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEE <br />CONTRACT PENCE OF WORK <br />HEATING SYSTEM: ❑GAS El ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE WVOLVED <br />� ' � <br />J a <br />CONTACT PERSON AND PHONE NO <br />o oS-7-v �Y � �• <br />J ! _ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND If NOW 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 OR <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 1 COMPLY WITH THE STATE <br />CONTRACT LAW 16.27 RCW AND 296.200 WAC. <br />X .it---c � 7� <br />osEo LISE of eaLallo <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW I A ATTACH TWO CORES) <br />LOT BLOCK OF—_ <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />S UR ATE <br />CI SINES, 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 />A/C —AMNDLG UNITS <br />T <br />' <br />,j. <br />BATHTUB <br />; <br />FORCED AIR SYSTEM, <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />]� <br />KITCHEN SINK 6 DISP <br />) <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />EXHAUST FAN <br />' <br />i— <br />, <br />I <br />, <br />� <br />SUB TOTAL <br />S <br />/ <br />SUB TOTAL f <br />/ ; <br />PERMIT <br />$ <br />,; U I <br />PERMIT f <br />TOTAL FEE <br />S <br />I 3 ' <br />TOTALFEE f <br />SETBACK <br />SIDE SETBACK <br />PLAN CHECK^NUMB//E__R <br />FEE <br />RECEIPT NO <br />V <br />I <br />TEA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑ NO <br />BUILDING <br />i <br />°DWELLING <br />SIZE OF BLDGRI <br />PLUMBING <br />/ <br />3C1 <br />MECHANICAL <br />PANTLOAD <br />BASEMENT <br />❑YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />) <br />i <br />)N <br />OTHER <br />7N <br />_ <br />STATE BUILDING SURCHARGE <br />i <br />I APPROVED BY <br />CITY OF EVERETT <br />PART IC WORKS <br />'— <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />