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APPLICATIC-A FOR CONSTRUCT73N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET I EVERETT, WA 98201 9259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING $ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZP' PHONE <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PIIONE STATE LICENSE <br />Cyo��is�al <br />MECHANICAL CONTRACTOR MAIL ADDRrAS CITY ZIP NONE STATE LICENSE I <br />a�I -a�i-qoG i <br />PLUMBING CONTRAC70R MAILADDRESS CITY ZIP PLANE STATE LICENSE <br />coNrRAcrPwcEOFWORK <br />HEATING SYSTEM: ❑ GAS Cl ELECTRIC ❑ <br />DESCRIBE V40RK AND SOUARE FOOTAGE INVOLVED <br />ry s 7,9,t a,-e7= CGs rw,r c <br />CONTACT PERSON AND PHONE NO C <br />� PK�'3SY�N 1 :Tr <br />l'Tck�A <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW ? H' 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 pR <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 LOCHS I,AW REGULATING CONSTRUCTION OR THE <br />PERFORMANCL OF iONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEP, I 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. C� <br />X l 9 ,7L " Z 6 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCWT04 OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK _ OF, <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE ' DATE <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 />A/C—A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />) <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />T <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 />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />GASRANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />I <br />' <br />EXHAUST FAN <br />I <br />I <br />I <br />I <br />, <br />I <br />I <br />I <br />SUB TOTAL <br />S <br />; <br />' <br />P SUB TOTAL $ <br />; <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE <br />$ <br />TOTALFEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑ NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG/TI <br />UNITS <br />PLUMBING <br />i <br />i <br />OCCCCUP NCY <br />NO O'SIMES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICALGUP <br />i <br />I <br />❑YES ❑ NO <br />ADDITIONAI PLAN CHECK - <br />FIRE SPRINKLER REO'D <br />REASON <br />OTHER <br />i <br />FIRE HARM REO'D <br />REASON <br />STATE BUILDING SIIRCHARGE <br />TYPE OF f.ONST <br />PLANS A'PROVED BY <br />CITY OF EVERETT <br />PIIBI IC WORKS <br />r <br />LOCAL SALES <br />— <br />— <br />%�l/ <br />TAX CODE IS 3105 <br />TOTAL <br />oILrE <br />I <br />