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APPLICATICosi FOR CONSTRUCT.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />F) DEMOLITION F1 COMBINATION n BUILDING I-1 MECHANICAL I 1 PLUMBING f l SIGN <br />PROJECT ADDRESS(�U11� {ng{7� Lo <br />OWNER le\fvmC / ( /J/ ADORES vZIP PHONE <br />ARCHITECT <br />CITY ,�• 'If T PHONE STATE LICENSE <br />y CITY ZIP PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADORE SS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />CONTRACT PRICE OF WJRK ,drf"-din HFATING SYSTEM: I I GAS FI ELECTRIC fl <br />DESCRBEWORK ANDSO'ARE FOOTAGE INVOV�D <br />CONTACT PERSONANDPH1 NO <br />• <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 />oPOSE USE Of RUII DING <br />aA4? - <br />_ <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTIONOF PROPERTY (SHOWN 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 REGJLATING CONS1r..UCTION OR THE <br />J'" <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />95057 <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />( WITH THE STATE <br />J� <br />Z�8 <br />CONTRAC ORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />)( <br />SIGNATURED F. <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />' <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS -H.P. <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />LAVATORY I VASO BASIN) <br />I <br />HEAT PUMP <br />' <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />KITCHEN SINK & DISP <br />' <br />' <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />' <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />WOOD STOVE <br />i.- <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' - <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />GAS RANGE <br />GAS P'F'ING <br />' <br />I <br />I ' <br />EXHAUSTFAN <br />SUB TOTAL <br />SUB TOTAL <br />$ <br />PERMIT S <br />PERMIT <br />$ <br />TOTAL FEE $ <br />TOTAL FEE <br />$ <br />' <br />FOR OFFICE USt U"LT: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER prp <br />RECPIPr NO <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />TUT AREA <br />VACANT SITE <br />I <br />I IYES II NO <br />BUILDING <br />' <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGUI <br />UNITS <br />PLUMBING <br />MECHANICAL <br />1 <br />i <br />OCCUPANCY <br />I NO OF STORES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />;IYES 11 NO <br />_ <br />I <br />AOCI I IONAL PLAN CHECK <br />-- <br />) <br />I <br />PIREALARMPEO'D <br />REASON <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />' <br />' <br />' <br />' <br />FIRE SPRINKIER RE OR <br />REASON <br />TYPE OF CONST <br />PI ANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />I <br />TAX CODE IS 3105 <br />TOTAL <br />i__ <br />DATE <br />_ <br />