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APPLICATIOrd FOR CONSTRUMON PERMIT <br />CITY OF EVERETT D BUILDING DIVISIO ' <br />3200 CEDAR STREET • EVERETT, WA 9B201 •259.8810 O:ff <br />1-1 DEMOLITION I I COMBIN OTION )(f BUILDING f l MECHANICAL PLUMBING f l SIGN <br />PROJECT ADDRESS 330 7And AS+, sue. <br />OWNER MAIL ADORE SS City 71p PHONE <br />JIuS J06sion <br />33v 7d"ISl-Sf— <br />rutc4f <br />�sS-90rjy <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />71P PHONE <br />MAIL ADDRESS _ CITY :IF PHONE STATE I-CFNSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />pr <br />PHONE <br />STATE LICENSE D <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP <br />PHONE <br />STATE LICENSED <br />CONTRACT PRICE OF WORK <br />35oD • G° <br />Q <br />HEATING SYSTEM: I 1 GAS Fl ELECTRIC n <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />/ <br />CONTACT PERSON AND PHONE NO <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />X-7� <br />PROPOSED USE OF BUIC <br />PROPOSED USE OF BUIL <br />j <br />olk <br />LEGAL oe'sc2mrRDN or RTYIs ow DR ATTACH TWO CO; -sl <br />LOT BLOCK __ OF i'A r o I" 6?rViie, <br />yo IL I y 04 i5 '95 <br />PARCEL TAM I D NUMBER <br />4D10 - 000- o/ 3 o003 <br />CONSTRUCHON IOMI LE1NOER. ADDRESS. TFLF.PIIONE NUMBER <br />C.hLA,S. <br />SIGNATURE DATE <br />CITY RUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. TYPE OF EOUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET(TO:LET) <br />' <br />A/C —A/HNDLG UNITS—H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYST EMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK d DISP <br />i <br />CLOTHES DRYERS <br />I <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />1 <br />WATER HEATER <br />I <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />i <br />SINK (SERVICE — BAR, ETC.) <br />1 <br />OAS RANGE <br />_ <br />_ <br />' <br />GAS PIPING <br />I <br />EXHAUSTFAN <br />1 <br />' <br />- <br />� <br />1 <br />I <br />� <br />I <br />� <br />SUBTOTAL S <br />' <br />SUBTOTAL S <br />' <br />PERMIT S <br />I <br />PERMIT $ <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SFTRACK <br />SIDE SETBACK <br />PLANCIIECK NUMBED <br />FEF <br />RECEIPT NO <br />USE ZONE <br />101 AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />IIYES fl NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDOnI <br />UNITR <br />PLUMBING <br />OCC�^ANCY IKl M AT(MKS <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />AYES II y0 <br />AWTIONALPLANCHECK <br />I <br />i <br />FIRE ALARM REDO <br />REASON <br />OWNER <br />i <br />FIRE SPRINKIFR REOD <br />REASON <br />/ 1 — <br />STATE BUR DING SURCHARGE <br />TYPE OrCOW <br />PLANS APPROVED sr <br />CITYOFEVERETT <br />Pustlr.wonKs <br />LOCAL 'ALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />