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APPLICATION FOR CONSTRUC'i ION PERMIT <br />CITY OF EVERETT F BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 4ArYr <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 5 09 i2 $ T SE E ewe hf y82 3 <br />TENANT MAIL ADCR:.SS CITY ZIP PHONE <br />0Nly 74Lt4 <br />CONTRACTOR MI <br />4` .Av <br />TAccac Za usc�n7tic <br />nr rHONF <br />llr <br />[/zsl ay.5ES/ T•i 11.4t G+6csrIh <br />MECHANICAL COI.TRACTOR MAIL ADDRESS CITY zip PHONT STATI. LICENSE, <br />PLUMBING CONTRACTOR MAIL DDRESS CITY ZIP PHONF -- STAFF I.ICENSE� <br />9 vo <br />CONTRACT PRICE OF MARK <br />— <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVF READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 1 O BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN ORNOT. 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. <br />V 'T <br />X� t ��(��� 4 7SKI-QIURE <br />PRDPOSFD USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY 151gWN BELOW OR ATTACH TWO COMESI <br />107 BLOCK DF <br />PARCEL TAX 1 D. NUMBER <br />CONSTRUCTION LOAN TENDER, ADDRESS. TELEPHONE NUMBER <br />DATE <br />CITY 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 />A/C—A41NDLO UNITS <br />—T <br />BAT'ITUB <br />; <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />, <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />; <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR. ETC.) <br />, <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />I <br />-- <br />, <br />I <br />_ <br />SUB TOTAL f <br />,' <br />SUB TOTAL f <br />; <br />_ <br />PER f <br />I <br />PERMIT f <br />�— <br />TOTAL FEE f <br />TOTAL FEE f <br />; <br />FOR OFFICE USE ONLY: <br />FRONT SFTDACK <br />RFAR SFTGACK <br />SIDE SFIBACk <br />PLAN CHECK NUMBrn <br />FEF <br />nFCFIPT NO <br />USE ZONF <br />lot AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />(]YES 0 NO <br />_ <br />T� <br />RIM GIN, <br />IIFIGIIT (IMITATION <br />NO OF DWELLING <br />SIZE W BIOGRI <br />— <br />IINRC <br />PLUMBING <br />-___-- <br />---- - <br />- _--_—�— <br />OCCUPANCY <br />N(f 0l allla'IS <br />OCCUPANT IUAD <br />BASEMENT <br />GROUP <br />MFCHANICAI <br />OYES No <br />ADd110NA1. PL AN Cur CK <br />FIRE SPRINKLER RED <br />RFASON <br />on,En <br />_ <br />FIRE ALARM REPO <br />RF AS OV <br />STAIr 91ulbIN6 SIIM:IURGI <br />- <br />--i-- <br />IYPEorr.oNST <br />PIANSAPPROVE DBr <br />CRY OFEVERETT <br />PIIpIIf.W(I1,KG <br />`-'--_— <br />LOCALSALES <br />— — <br />TOTAL <br />-- — <br />— <br />', <br />GATE <br />TAX CODE IS 3105 <br />