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APPLICATION FOR CONSTRUMUN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING a MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT S •-B� <br />T ADDRESS: AS SI-R5TF-' S <br />P' _ <br />)GIUA/A aAn AtC, X IC11 _ /A110 1—l- .CC s ol.ii <br />TENANT MM; ADDRESS CITY ZIP PHONE <br />DESIGNER MAN ADDRESS CITY 71P PHONF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY 71P PHONE SULIL PUN%F <br />nA0v1%IAAnIPW-k �N(} di.IL7 E09&,P IU- I.U•i 4 i F.ICOGT t(),exit 7.C-11f/P kr-Az.tua/ /.n E%,.I <br />71P <br />LICENSE R <br />MUMBNO CONTRACTOR MMLADDRESS CITY ZIP PHONF STATE LICENSF. <br />OL.l'71) l <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: VGAS ❑ ELECTRIC ❑ <br />DESCRIBE WORN AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHOr1;Z rVl <br />EG�c� TO �+"T� CON /eRSCo/J <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 />CONTRACTORS LAW <br />/ 1B 27 RCW AND 296.200 WAAC. <br />Y .Q ICY_ . _} ) o -,j <br />""'_..•• <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK Of <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION LOAN I.EM)ER. ADDRESS. TELEPHONE NUMBER <br />ATURE DATES_ <br />IICITY <br />BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />AID —AIHNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />) <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />T <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />; <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />1 <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />; <br />SINK (SERVICE —BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />EXHAUST FAN <br />I <br />I <br />I <br />1 <br />SUB TOTAL S <br />' <br />SUB TOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />fRONTSPTBACK <br />RFAR SFTBACK <br />SIDE SETBACK <br />PLAN CHECK NUMRFR <br />fFF <br />RFCFIPT NO <br />J6, )C, <br />USE ZONF <br />I Of AREA <br />VACANT s'E <br />FEES <br />VALUATION <br />FEE <br />_ <br />❑YES ❑ NO <br />BLRIDINC. <br />) <br />HEIGHT 11MITAIION <br />NO OF DWELLING <br />SIZE Of BLDGRI <br />1 <br />UNITS <br />PIVIORING <br />' <br />OCCUPANCY <br />NO PI SPORTS <br />OCCLIPANT LOAD <br />BASFMENT <br />Mf CHANK.AI <br />onwe <br />OYES O NQ <br />ADd1lONA1 PUNCHCCK <br />' <br />i <br />FIRE SPRINKLER REO'D <br />REASON <br />1THER <br />I <br />' <br />FIRE ALARM REG'D <br />RFASOY <br />'•� <br />SPAN' BIMILPING 511RCHARRF <br />J <br />TYPE Of CONS( <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PIP PHI IC WORK; <br />- <br />'— <br />LOCAL SALES <br />— <br />TAX CODE IS 3105 <br />TOTAL <br />1 <br />DATE <br />