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APPLICATI ni FOR CONSTRUCY`JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITICN b COMBINATIO,N ❑ BUILDING CJ MECHANICAL B(PLUMBING ❑ SIGN <br />PRO zECT ADDRESS: to/ -�o /9/ 1, A <br />\11u)(e -1;;` r h&,VG 3 2,/ zA 1 nr. r7- zw""A, . K A 9B',?z <br />,MP'- 22 lauL-., <br />MAIL ADDRESS CITY <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Co91�10 <br />FD <br />1�2�S�y9a <br />GENERA CONTACTOR MAIL ADD ESS <br />CITY <br />21P <br />PIIUNE SPATE UCENSE6 <br />cy" c a s-- '3 I <br />MECHANICAL CONTRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATELICENSEF <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />T ,_,' <br />CO T PERSON AND PHONE NO. <br />3495 -O� 58�-�ayo <br />• SfT• •!.�• <br />! Gtet•C-� <br />«`�tT92Y <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 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 I COMPLY WITH THE STATE <br />CONTRACT LAW 18.27 RCW AND 296.200 WAC. <br />X �z L` <br />PFIOPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PAFY.,EL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />S UR ATE <br />CI USINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDIG UNITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />Z� <br />ITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />i <br />DIRSUINASHER <br />' <br />RANGEHOOD <br />' <br />EAU Y TRAY <br />; <br />WATER HEATER <br />CLOTHE ASHER <br />I <br />WOOD STOVE <br />' <br />URINALN, <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUtllrAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENT <br />; <br />GASRANGE <br />SINK (SERVICE - BAR, ETN <br />GAS PIPING <br />' <br />EXHAUST FAN <br />' <br />1 <br />' <br />I <br />' <br />1 <br />' <br />SUB TOTAL <br />S <br />; <br />SUB TOTAL E <br />PERMIT <br />$ <br />I <br />PERMIT S <br />I <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />`` <br />l -;7& <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />OYES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGR.I <br />UNITS <br />PLUMBING <br />' <br />T <br />OCCUPANCY I NO OF SIORIES <br />OCCUPANTLOAD BASEMENT <br />MECHANICAL <br />GROUP <br />OYES ❑ NO <br />ADDITIONAL PLANCHECK <br />, <br />FIRE SPRINKLER REO'D <br />REASON <br />OTHER <br />FIRE HARM REO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF C,pNST <br />PLANS PROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />O' <br />LOCAL SALES <br />--�— <br />5 - [ <br />TAX CODE IS 3105 <br />TOTAL <br />DATE - <br />