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ga <br />APPLICATIC'A FOR CONSTRUCZ ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 96201-259-8310 <br />❑ DEMOLITION ❑ COMBINATION �i❑BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 1C ��� /y' (CG2° J X % a <br />l,_ <br />AW,MTtCT SIGNER <br />ESS <br />CITY <br />ZIP <br />PHONF <br />GENERAL CONTRACTTAOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />°HONE <br />STATE LICENSE <br />It <br />—_ <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />� i � J <br />HEATING SYSTEM: ❑GAS DIELECTRIC ❑ <br />DESCRIBE WORK AND ARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NU <br />CHuA)i� lt'lkl <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 />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY IS#OWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK of <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 />- <br />CONTRACTORS LAW 1B.27 RCW AN 296.200 WAC. <br />PARCEL TAX I D NUMBER <br />�} S <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />ATURE DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—AMNDLG UNITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK III DISP <br />¢ <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />RANGE HOOD" <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS PIPING <br />' <br />' <br />EXHAUST FAN <br />I <br />I <br />, <br />I <br />' <br />I <br />) <br />SUB TOTAL S <br />' <br />SUB TOTAL f <br />) <br />PERMIT <br />PERMIT f <br />' <br />TOTAL FEE f <br />' <br />TOTAL FEE S <br />' <br />O^ft ^001^e Iloo f1A11 V. <br />•v <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN NUMBERVFFFRECEIPT <br />NO <br />.CCHECK <br />v <br />USE ZONE <br />LOTAREA <br />VACANTSITE <br />ES❑NOBUILDING <br />FE S <br />FEE <br />HEIGHT LIMITATION <br />NO. OF DWSLUNG <br />SIZE OF BLDG/TI <br />UNITS <br />D L7 <br />PlI1MBINGOCCUPANCY <br />ND TX SIDRES <br />P❑YES <br />OCCUPANT LOAD BASEMENTMECHANILALG <br />NO <br />PLAN CHECK�I/✓' <br />�FIRE <br />SPRINKLER REO'D <br />REASONADDITIONAL <br />OTHER <br />rJU <br />FIRE ALARM REO'D <br />N' <br />REASON <br />STATE BUILDING SURCHARGE <br />— <br />' <br />JQ <br />PIIBI IC WORKS <br />J _ <br />TYPE OF C,ONST <br />PLANS APP FD BY <br />CITY OF EVERETT <br />V A / <br />.4 <br />oerE - -� G <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />-' <br />2ZJ ' <br />