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APPLICATIA FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 257-8810 <br />i, DEMOLITION -. COMBINATION BUILDING MECHANICAL F1 PLUMBING -' SIGN <br />PROJECT ADDRESS <br />/! / ✓ <br />TIT /1/ �/ MAILACOOORO Ess CITY ziP PHONE <br />{ <br />TENANT MAR'ADORE` SS CITY ZP PHONE <br />ARCHNECTORIIDDE�SSIOW14 MNyLAADDOOIPESS CRYY PHONE <br />'CIS, F�Z�P(y E. <br />�� �),r <br />GLRFiRAL LON/1 //fXy 'I "/ �•BBT/� /U'/ ///✓/Y /'.//UG�12 BTATE}%// <br />MECHANICAL CONTpACrOR MARApdIE55 CITY ZP PNg2 STATE LICENSE <br />PLUMBINGCONTRACTDP M ADd1ESS CITY ZP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />md: <br />HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE IWOLVED <br />CONTACT PERSON AND PHONE NO <br />1Y s l rnotir 4 dl+E � <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. THAI 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 (�j�//(/ / //-OO <br />PaOPOSFOOBE of BUILdIw <br />LEGAL DESCRIPTION OF PPOPERTY ISNDWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAX I D. M ARY <br />CONSTRUClXDN LOAN (ENDER ADDRESS. TELEPHONE NUMBER <br />9GNANHE DATE <br />CITY BUSINESS LICENSE HA. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —NHNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />! <br />UNIT HEATERS <br />j <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />RANGE HOOD <br />1 <br />LAUNDRY TRAY <br />WATER HEATER <br />! <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />! <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />! <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS PIPING <br />! <br />EXHAUSTFAN <br />j <br />I <br />j <br />i <br />I <br />! <br />i <br />SUBTOTAL $ <br />j <br />SUBTOTAL 5 <br />! <br />PERMIT $ <br />j <br />PERMIT S <br />TOTALFEE $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIM SETBACK <br />PLAN CHECK NUMBER <br />momq-otG <br />FEE <br />RECEIPT NO <br />USE ZONE <br />HIJOHTl14RATION <br />p pWNLY I NOCFSFpES <br />FWESPPWKLERREGD <br />iPE AURM PE00 <br />TYPE OF CONST <br />LOTAPEA <br />VACANT SITE <br />OYES 0 NO <br />FEES <br />VALUATION <br />FEE <br />— <br />BUILDING <br />NO OFDWIDUING <br />UNITS <br />SDECFBUM l <br />PLUMBING <br />OCCUPANT LOAD <br />BASEMENT <br />DYES ❑ NO <br />MECHANICAL <br />ADORICNALPIANCNELK <br />REASON <br />OTHER <br />PERSON <br />STALE OUADWG SURCHARGE <br />PLANSAPPRQeEDBY <br />DAM <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />