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APPLICATION FOR CONSTRUCTIL A PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET F EVERETT, WA 98201 A 259.8810 <br /> n DEMOLITION 1-1 COMBINATION I I BUILDING I MECHANICAL 1-1 PLUMBING n SIGN <br /> PROJECT ADDRESS <br /> OWNER _ MNLADDRESS f CITY ZIP PHONE <br /> K:7 T�tJt CLA-ICK <br /> TENANT MNLADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MNL ADDRESS CITY ZIP PHLHIE STATE UCEK$L9 <br /> MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE UCENSE8 <br /> PLUMBING CONTRACTOR MNLADDRESS CITY ZIP PHONE STATE LICLNeEI <br /> CONTRACT PRICE OF WORK —7 <br /> � Z /c,C) . �Co HEATING SYSTEM: 91'GAS ❑ ELECTRIC fl <br /> 0E6CRIBE WORK AND SOLIME FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> "—ALL <5 Oa -`(k <br /> NAll)f 'L � AI' F-tj"A�(-F I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING 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 /> LEGAL W WRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK of 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 TAA I D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADDRESS.TELEPHONE NUMBER <br /> SIGN <br /> fUREI f GATE <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 ATC—A/HNDLG UNII S—H.P <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. 74 <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER ' UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS <br /> DISHWASHER ' VENTILATION FAN <br /> LAUNDRY TRAY RANGE HOOD ; <br /> CLOTHES WASHER I WATER HEATER �— <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS GAS FIREPLACE <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE <br /> ' GAS PIPING <br /> EXHAUSTFAN <br /> I ' <br /> I <br /> I <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S I PERMIT 5 <br /> TOTAL FEE $ ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PUN CHECK NU R FEE RELEIPT NO. <br /> , <br /> USE ZONE LOT AREA VACANT SITL FEES VALUATION FEE <br /> nY[S IBUILDING <br /> HHOHT LIMITATION NO OF DWELLING SIZE OF BLOGnI <br /> UNITS PLUMBING <br /> OCCUPANCY NO Of 61069ES OCCUPANTLOAD BASEMENT MECHANICAL <br /> GROUP <br /> nrrs n No <br /> FIREALARMREOD REASON _ -10IRONAL PLAN CHECK I <br /> n ' <br /> FIRE SPRINKLER REMD REASON ' <br /> I <br /> IE BUILDING SURCHARGE ' <br /> I <br /> TYPE(*CONST PIANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES ; <br /> DATE TAX CODE IS 3105 TOTAL <br />