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APPLICATICO FOR CONSTRUCTOiN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS /9 <br />OWNER MAILACDRESS / CITY Bp PHOWE <br />ZIP <br />MECNANICAI CONTRACTOR MAILA004E55 CITY IW PHONE STATE IICENSEF <br />CON RACi PRICE OF WOR�y <br />Y(; oCx) <br />DESCRIBE WgIK ZJIO SWARE FOOTAGE IM0.VE0 <br />HEATING SYSTEM: C GAS L1 ELECTRIC ❑ <br />CON ACT PERSON AND PHONE IQ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLI2D 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X_ <br />v4ovoseD USE of BUILDING <br />LEOA. DESCRIPTION V PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK of <br />^'1 <br />5 7 3 <br />PARCELTAK IDQ <br />CONSTRUCTION LOAN LEFQEN, ADDRESS. TELEPHONE NUMBER <br />9GNATURE 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 —AIHNDLG UNITS <br />BATHTUB <br />FORCED ' IR SYSTEMS <br />LAVATODY(WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGER/ J <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />j <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPI ACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIPEPLACE <br />BACKFLOW PREVENTERS <br />_ <br />GAS RAN::E <br />SINK (SERVICE - BAP, E'FC.) <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />- i <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBA;K <br />BIDE SETBACK <br />PUN NECK NUMBER <br />^ <br />FEE <br />RECEIPT NOAz . <br />DSEZONE <br />LOTAKEA <br />VACANTSITE <br />DYES D NO <br />FEES <br />VALUATION <br />FEE <br />BUKDUQ <br />iZS,Z7 <br />HEIGHTLIMITATION <br />IND Of DWELLING <br />UNITS <br />SIZEOFBLWRI <br />PLUMBING <br />CCRCcUPANCY <br />UR <br />Y <br />RousloFBS <br />C:CUPANTLOAD <br />BASEMENT <br />DYES ❑ NO <br />MFCHANICAL <br />CHECK <br />FIRE SPRINKLER REDD <br />REASON <br />OTHER <br />FIRE AUNM RE <br />REASON PEASJ <br />/ <br />STATE BUILDING SURCHARGE <br />Q-52) <br />TYPE OF CoxsT <br />C o'bm • E <br />PwlsnvP r <br />DATE -60 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />