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APPLICATION FOR CONSTRUCT iON PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL Il PLUMBING - fI�SIGN <br /> E <br /> PROJECT ADDRESS 7q-1 ) /n/ J� j 1 <br /> OIN D MNL ADDRESS CITY Tip PHONE I <br /> 1 ?OrUAI /syi! zyz^ NSiF Crei 3/a P3rei __ <br /> TENANt MAIL ADDRESS CITY TIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MNL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF WORK <br /> HEATIVG SYSTEM: I,FGAS Fl ELECTRIC 1:1 <br /> DESCRIBE WORN AND SQUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO <br /> 0 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED 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 B-LOW OR TTACn 1V/O coPlEsl _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT16 BIO:H GF L-SYa}� 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 JS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX 10 NUMBER CONTRACTO LAW 18 27 RCW AND 290.200 WAC. <br /> 7 <br /> CONSTRUCTION LOAN TENDER,ADDRESS.TEL EMIONE NUMBER ( /yt1- <br /> SIGN UR DATE <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) I AIC—ARiNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i HEAT PUMP y_ <br /> / SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISHWASHER i VENTILATION FAN ' <br /> LAUNDRY TRAY I RANGE HOOD <br /> / CLOTHES WASHER fWATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN N METAL FIREPLACE(WOOD BURNING) <br /> / FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVCNTERS I OAS FIREPLACE ' <br /> I <br /> SINK(SERVICE—BAR,ETC) 1 GAS RANGE ' <br /> ' OAS PIPING ' <br /> I EXHAUST FAN i <br /> 1 ' <br /> 1 ' <br /> SUB TOTAL $ ' SUB TOTAL S ' <br /> PERMIT $ I PERMIT S I <br /> TOTALFEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK / REM SETBACK _ SIDE SETBACK / PIANCHECK NUMBF., FEE RECEIPT NO, <br /> USEZON J / NOT AREA VACANT SITE S FEES VALUATION FEE <br /> III/ nYES 11 ND BUILDING <br /> HEIGUt LIMITATIIgN —/ NO OF DWELLING SIZE4B j�rtl� I�N�4 <br /> 'LJ-CLJ� UNITS PLUMBING <br /> 576 S. G/TR/TGG <br /> OCCUPANCY 110 OF STONES OCCUPANT LUAU BASEMENT MECHANICAL <br /> CtRD* U-i I Z I []YES w1ro <br /> FIRE ALARM REO') REASON ADDITIONAL MAN CHECK 7 �— <br /> _ OTHER <br /> FINE SPRINKIERREO'D REASON _ <br /> STATE BUILDING SURCHAGGE <br /> TYPE OF CONST PLANS MPROVEq BY CIT1'OF EVERETT PUBL IC WORKS 2 <br /> J11 LOCAL SALES 2 <br /> -// DATE TAX CODE IS 3105 TOTAL <br />