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APPLICATI& FOR CONSTRUCI%N PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 998201 A 257-8810 <br />CT DEMOLITION ❑ COLiBINATION ❑ BUILDING NMECHANICAL ❑ PLUMBING 0 SIGN <br />PROJECT ADDRESS cto <br />!DRESS <br />-J <br />caue <br />St <br />OWNE M,iL AD <br />f.ItY <br />PHONEov W'35YM ^4o <br />TENANT MAIL ADDRESS <br />Lrtv <br />bP <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PNM <br />GENERAL CONTRACTOR MAIL ADDRESS CHZN PIMX STATE LICENSE <br />CGNTNACTPRICE a'f. sI( <br />, <br />9 <br />ZIP <br />HEATING SYSTEM: ❑ GAS L14LECTFIIC ❑ <br />DISC O[WOR4AN05U IEFpOTIAN YED <br />C/ <br />n5 �1NClPfi4 H <br />CONiA�C yCyRSIN�f,A%I�P 9C ItC /��Z ^J <br />s� / i �r G <br />zMD SG <br />1 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 />CONTR SLAW 16.27, CW ,AND 296.200 WAC. <br />X f-2?-ad <br />PROPOSE �uS,fiGF BUILD:rq <br />: 1 <br />LEGAL DESCHIPTION CA PROPERTY ISIKYVM BELGW OR ATTACN➢N'O OdRES) <br />LOT BLOCK e<_ <br />PARCEL TAX ID NUMBER <br />CONSTRUCTION LOAN RENDER, ADDRESS TEUI INE NUMBER <br />SIGNA iAIE <br />CItY DUSMCS HCENSE INI <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 />0.'C—NHNDLG UNITS <br />BATHTUB <br />1 <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />j <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />i <br />WOOD STOVE <br />URINAL <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />j <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />1 <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.I <br />GAS PIPING <br />I <br />EXHAUSTFAN <br />i <br />i <br />i <br />SUBTOTAL S <br />I <br />SUBTOTAL 5 <br />j <br />PERMIT 5 <br />i <br />PERMIT $ <br />TOTAL FEE S <br />TOTALFEE S <br />one ... nNI V. III N/Yl/. - ,n l <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUIREN <br />FEE <br />RECEIPT ND <br />USE ZONE <br />LOT AREA <br />VACAIRSITE <br />FEES <br />I VALUATION <br />FEE <br />BYBNNO <br />ons In NO <br />HEIGHT LMITATICH <br />NO CF ONVELLING <br />STZE Of MIDDIN. <br />PLUMBING <br />OCCUPANCY NONS1DR45 <br />OCCUPANT LCLD BASEMENT <br />MECHANICAL <br />T <br />GROUP <br />DYES ❑ No <br />FIRE SPRINKLER RED D <br />REASON <br />ADp1iNJNALPLAN CNECM <br />OTHER <br />FNEAIARM PEOD <br />REASON <br />STATE BUNTING SURCHARGE <br />TYPE OF CIXRT <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC N9RKS <br />LOCALCOSALES <br />DAYS <br />TAX DE IS J105 <br />TOTAL <br />