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APPLICATIO.,d FOR CONSTRUCT6,jN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION p COMBINATION ❑ BUILDING El MECHANICAL PLUMBING ❑ SIGN <br />PROJECT ADDRESS:. �)n I0-ftI C>i l�l�e-4-- .I <br />Cm <br />TENANT MAIL ADORC SS CITY TIP PHONE <br />OR <br />GENERAL CONTRACTOR <br />lip PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: I KGAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONT <br />P[RSONA (P ONE NO r - <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 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 />CONTRA TORS LAW 16.27 RCW (AND 296,200 WA`C.. / <br />XMlo&A JL �- /L.JI —^J / 6 <br />PROPOSED USE OF BUILDING �j <br />I \ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PAPA:ELT <br />Nu <br />CONSTRUCTION LOAN LENDER. ESS. TELEPHONE NUMBER <br />SIGNATU 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 —AMNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />_ <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 6 DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD URNING) <br />i <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />1 <br />' <br />1 <br />SUBTOTAL E <br />SUBTOTAL E <br />PERMIT $ <br />PERMIT S <br />TOTALFEE $ <br />' <br />TOTALFEE S <br />' <br />cno nialrc Imp nMl v <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECNUMBER l% <br />FEF <br />RECEIPT NO <br />O✓ <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />Dunnwr, <br />I <br />❑YES ❑ NO <br />_ <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGR I <br />UNITS <br />PLUMBING <br />' <br />T <br />OCCUPANCY <br />NO OTSTORES <br />OCCUPANTLOAD <br />BASEMENT <br />MECIIANICAI <br />I <br />OR OUP <br />1 <br />ADUIIIONAI. PLAN GIFGK <br />i <br />DYES ❑ NO <br />FIRE SPRINKLER REO'D <br />REASON <br />On1En <br />FIREALARMREOO <br />REASON <br />STATE (HIRDING SUnCHAnOE <br />PIISIICWOnKS <br />--�— <br />TYPE OF f,ONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />_ <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />