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APPLICATILIA FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 A259.8810 <br />DEMOLITION fl COMBINATION CI BUILDING ❑ MECHANICAL (l PLUMBING n SIGN <br />rnv,Fcvl FAvvncaa I <br />OWNER MAILADDRESS CITY ZIP PHONE <br />,T/l�V G v 7 C I -� YGf <br />TENANT MAIL ADDRESS CITY lip PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY lip PHONE <br />GENERAL CONTRACTOR MAILADDIIESS CILY /IP PHONE STATE LICENSE <br />PHONE STATE LICENSE F <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: f_l GAS ❑ELECTRIC C7 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <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 ORDINi1i 3 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 18.27 RCW AND 296.200 WAC. p <br />y�' � / 7'/ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWOCOPIES) <br />LOT BLOCK OF <br />PARCEL TAX 10, NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIOI�)RE 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 FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C — AMNDLG UNITS — H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />, <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />) <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />, <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />! <br />SACKFLOW PREVENTERS <br />i <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />' <br />, <br />, <br />T <br />SUB TOTAL S <br />' <br />SUB TOTAL S <br />' <br />PERMIT S <br />, <br />PERMIT $ <br />1 <br />TOTALFEE $ <br />' <br />TOTALFEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />pER <br />PUN CHECK PM <br />Gi n <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />RYES n NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF FAGOT I <br />PLUMBING <br />MECHANICAL <br />OCCUPANCY NO OF STORES <br />GROUP <br />FIRE ALARM RED1) <br />OCCUPANILOAD BASEMENT <br />❑YES n NO <br />REASON <br />ADDITIONAL PLAN CHECK <br />OTHER <br />FIRE SPRINKLER RED <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TYPE OF CONST <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />