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1-1 <br />APPLICATION FOR CONSTRUCTeON PERMIT <br />CITY OF E JERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />n DEMOLITION f 1 COMBINATION Fl BUILDING I7F<4mFrwANlrAi r, of nualur_ I I clr_u <br />IROJECT ADDRESS Q&0&2Iq Tli kX `i �—20 <br />\ <br />NNER ADDRESS TMnPN <br />MAILADDRESS CITY ZIP PHONE SLATE LICENSE. <br />MECHANICAL CONTRACTOF. MAILADDRESS <br />CITV <br />ZIP <br />PHONE STATE LICENSE. <br />'LUMBING CONTRACT MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE• <br />CONTRACT PRICE OF WORK-- <br />. QllC)Q <br />HEATING SYSTEM: I 1 GAS Fl ELECTRIC F-1 <br />CG,. U.C. PEtj .RSONAND p{t 1NE N0.— <br />O[SCRIBE WJHn a.'D SQUARE FOOTAGE INVOLVED <br />��nta� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNC'N 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 />C E`Tfl S W 18.27 RC W AND 296.200 WAC. <br />X L <br />PROPOSED uSE GF BUILDING - <br />�� 1Ath`S �t�,tA e►o.A�IK <br />LEGALDESCRIPTIC'IFPROPERTY(SHOWN BELOW OR ATTACH TWOGOPIES) <br />LOT _ FLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION 1 DAN LENDER. ADDRESS. TELEPHONE NI IMBER <br />SIGNATURE FIATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. OF EOUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />_TYPE <br />A/C-A/HNDLG UNITS - H.P. <br />�- <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />, <br />SHOWER <br />I <br />UNIT HEATERS - B.T.U. M <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER _ <br />WATER HEATER <br />URINAL <br />I <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />i <br />GAS FIREPLACE <br />' <br />SINK (SERVICE - BAR, ETC.) <br />_ <br />GAS RANGE <br />I <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />i <br />I <br />_ <br />I <br />SUB TOTAL$ <br />SUB TOTAL $ <br />PERMIT $ <br />—i— <br />_ <br />PERMIT $ <br />TOTALFEE $ <br />_ __-L- <br />TOTAL FEE S <br />FOP. OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USE ZONE <br />f0'f.BtA <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />UNITS <br />OCCUPANCY <br />GROUP <br />NO OT StOP�LS <br />OCCUPANT LOAD <br />FIRE ALARM REOT <br />REASON <br />FIRE SPRINKLER RED'D <br />REASON <br />TYPE OF C,ONST <br />PIANSAPPROVFD <br />DATE I Y®/ <br />SIDE SETBACK I PLAN CHECK NUMBER <br />VACANT 5NE <br />AYES NO <br />FEES <br />BUILDING <br />SIZE OF BIDGR I <br />PLUMBING <br />BASEMEN' <br />IIYES II NO <br />MECHANICAL <br />ADDITIONAL. PI AN CHECK <br />OTHER. <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />PEE I RECEIPT NO <br />