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APPLICATIOw.I FOR CONSTRUCTI.IN PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET A EVERETT, WA 98201 •259.8010 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: <br /> OWNF.h MAIL AOOFFSS CTTY lir PHONE <br /> � <br /> / ��f/a�f•'s7e✓ /�yi�F- z SY�/JtL`sr /1J7// �. rF,t' 3/l• f.3�r1 <br /> TENAN MAIL AFKAHS5 CITY 71P PnMI[ <br /> 7ATKMIECT OR DESIGNER MAIL ADDRESS CITY 71P PHONF <br /> 1IM7 1A61&jWIIA MII ) c "',S A11Q,V ., plc' a4a >to� 3s41 <br /> OCNEnAL CONTRACTOR MAIL ADDRESS CITY 7? PHONE STATE IICENSE L <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY 71P PIIONF STATE LICENSE F <br /> PLUMBWGCONTRACTOR MAIL A00RESS CITY 71F PHONE STATE LICENSrI <br /> CONTRACT PRIG:OF MORN <br /> HEATING SYSTEM: EIGAS El ELECTRIC ❑ <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO <br /> f c <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> — APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> P1 J IDSED USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW ORA AGN TWO COPESI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ,GT /4• BLOCK ar tc�t..-C 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 /> PARCEL TAI10.NUMBER CONTRACTORS LAW 16.27 RCW AND 256.200 WAC, <br /> CONSTFIUCP014 LOAN LENDER.ADDRESS.TELEPHONE NUMBER X <br /> SIGNATURE DATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _ WATER CLOSET(TOILET) A/C—AMNDLG UNITS <br /> Z BATHTUB ; / FORCED AIR SYSTEMS <br /> _j LAVATORY(WASH BASIN) HEAT PUMP _ <br /> SHOWER ' UNIT HEATERS <br /> r KITCHEN SINK 6 DISP CLOTHES DRYERS <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ) WATER HEATER — <br /> j CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) 1_ <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; / GAS RANGE <br /> SINK(SERVICE—BAR,ETC.) ! GAS PIPING <br /> EXHAUST FAN <br /> I T <br /> SUB TOTAL S ' SUB TOTAL S <br /> PERMIT S H PERMIT f <br /> TOTAL FEE S ' TOTAL FEE f <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACKRFAn SFTBACK SIDE SE TRACT / PIAN CHECK NUPOFn FLT PFCFIPT NO <br /> ZoI 7� I e <br /> USE ZONE IOU AREA VACANT SITE FEES VALUATION FEE <br /> r <br /> DYES D NO BUILDING <br /> NEI611i IUMHTATI N NO OF DWEl111O 54E M BLDOeI _ <br /> -z, UNITS 16"1 S,f, /—IVW4t PLDMnwn ' <br /> w 0 U�ANCr NO(M SI(Nb[5 OCCUPANT LOAD BASEMENT � �U� MFCIIAMUIon --- <br /> ✓� Z ❑ N' <br /> YFS NI <br /> FIRE PRINKLEIIR 'OEOnFASON ADDIIIONAI PI AN CRTCk y��7 <br /> OIHEn I_ <br /> FIRE AIARM REVD RF ASON —�15K <br /> STATE BAIL GING SIInr.HARGE <br /> TYPE OF CONST PI ANS APPnO1F D BY CITY OF EVERETT PURI Ir.Y RK s _ 20-j <br /> �J PL LOCAL SALES <br /> - ,{ DATE 1 TAX CODE IS 3105 TOTAL <br />