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APPLICATICA FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERE FT, WA 98201 •259.8810 <br />rI DEMOLITION F1 COMBINATION F I BUILDING Iv MECHANICAL I I PLUMRING I SIrN <br />PROJECT ADDRESS <br />O� <br />�� <br />ry� S� <br />i <br />OWNER I <br />MAIL ADDRESS <br />21P nHnuc <br />MAILADDRESS M QIP/ ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIICNE <br />STATE LICENSE• <br />/MECHANICAL <br />� / <br />�H/yrL�Ri /��irrnu—aTcw� <br />�}/�Z/q�e Nk/ <br />Ah�wru <br />48oc�/ <br />Gf/JJVEIP//S9/CF <br />PLUMBING CONTRACTOR I <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE'STATE <br />LICENSE <br />CONTRACT PRICE OF WORK ,y <br />JT %� � <br />- <br />HEATING SYSTEM: 11 GAS F I ELECTRIC 11 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Grter- /4 t/R /ce <br />t <br />CONTACT PERSON AN ^HONE NO <br />e_(Z <br />Z. - Clq;p5 .Z C.eop�/Hoods <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 S-TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE Or 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC <br />MMMY� // • Z3 <br />PROPOSEF USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW ORATTACH TWOC.OPIES) <br />LOT _ BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN FENDER. ADDRESS. TELEPHONE NUMBER <br />SIL; RE DRf <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />_ <br />_TYPE <br />A/C -A/HNDLG UNITS-H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />T� <br />SHOWER <br />' <br />UNIT HEATERS - B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />WATER HEATER <br />—�— <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />; <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />; <br />SINK (SERVICE - BAR, ETC.) <br />GAS RANGE <br />�— <br />GAS PIPING <br />EXHAUST FAN <br />_ <br />_ <br />Ice- #"-?d la+G <br />_ SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />PERMIT <br />$ <br />I <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />EIOE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECFIPT NO. <br />LSO/3 <br />USE ZONE <br />TOT AREA <br />VACANT SHE <br />FEES <br />VALUATION <br />FEE <br />HYES 11 NO <br />I <br />BUILDING <br />HEIGHT LIMITATION <br />NOGF DWELLING <br />SIZEOFBLDG21 <br />L'^l1TE <br />PLUMBING <br />I <br />OCCUPANCY <br />NO OF Si0R1EE <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />MECI:ANICAL <br />AYES II NO <br />PODIIIONAL PLAN CHECK <br />- <br />-- <br />i-- <br />FIREALARMREOD <br />RFASON <br />OTHER <br />- <br />FIRE. SPRINKLER RED <br />_ <br />REASON <br />STATE BUILD-'G SUHCMARGE <br />-- <br />TYPE OF CONST <br />PI ANS APPROVED;9Y <br />CITY OF EVERETT <br />PUB( IC, WORKS <br />JM <br />LOCAL SALESrEIr <br />TOTAL <br />TAX CODE IS 3105 <br />