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APPLICATIL A FOR CONSTRUCI.ON PERMIT <br />ZITY OF EVERETT r BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 r 259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLU,ABING Cl SIGN <br />PROJECTADDRESS: 1-7If)l /.j717d (-T- GT /ii_,ort- 1i/14 017.?,7r,-? <br />MAIL ADDRESS CITY <br />ARLLATECT On DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTnAC1GR MAIL ADnnt SS CRY <br />ZIP <br />PHONE <br />SIAIE LICENSEr <br />AVr)ytz.l7oryll S11 _. /L'C(i! 16 l t✓ 1 t 9^1 _ <br />�l S� Z_72 <br />>' —1 5/l <br />fJI JL�2jf /(v0 A/ % <br />MECHANIC C NTnACTOR MMl A ESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE r <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />Cd1T1UC1 PRICE OF WORK <br />(c(qq, <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />T 5f )uuo 8 LYP <br />r <br />- ICJ Fit-C letee JTr15 6-7/: <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 />CONTRRAAACTORS LAW 18.27 RCW AND 296.200 WA%C. <br />X_ /�,�/d /!I / i 211-q� <br />PROPOSED USE OF Bala <br />LEGAL DESCRIPTION OF PROPERTY ISIOVM BELOW DR ATTACH TMCOPIES) <br />LOT BLOCK .F <br />PARCEL TAR I D. NUMBER <br />CUNSTRIILTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />SON--ATUR 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 />' <br />A/C—A/HNDLG UNITS <br />I <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />H <br />KITCHEN SINK 6 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />) <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD PURNING) <br />DRINKING FOUNTAIN <br />) <br />FIREPLACE INSERT (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />' <br />SINK (SERVICE —BAR, ETC) <br />GAS PIPING <br />EXHAI IST FAN <br />SUB TOTAL f <br />' <br />SUB TOTAL f <br />PERMIT f <br />I <br />PERMIT f <br />TOTAL FEE f <br />' <br />TOTALFEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRpNTSETBACK <br />REAR SFTBACK <br />SIDE SETBACK <br />PI AN CHECK NUMB <br />FEF <br />nrCFIPI NO <br />rd3,� <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑ No <br />WILDING <br />I <br />/IEIDHIT LIMITATION <br />NO OF DWELLING <br />SIZE OF B100/TI <br />UNITS <br />PLUMBING6 <br />OCCUPANCY <br />NO GH SIM6 <br />OCCUPANT TOAD <br />BASFMFNI <br />{ <br />RC <br />MECHANICAL <br />- <br />OYES ❑NO <br />- <br />ADDITIONAL PLAN CIIrCK <br />-- <br />- <br />FRESPRINKLERREOD <br />REASON <br />OTHER <br />iIRF ALARM RED <br />RF A.R N <br />STATE BUILDING SHnMIAnGE <br />TYPE Or rON51 <br />PIANS APPROVF D BY <br />CITY OF EVERETT <br />PI'AIIC wonKs <br />LOCAL SALES <br />- — <br />— <br />TOTAL <br />pAtE <br />TAX CODE IS 3105 <br />