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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING <br />3200 CEDAR STREET • EVERETT, WA 98201 R201 -259-8810 <br />11 DEMOLITION 11 COMBINATION I I BUILDING I MECHANICAL I I PLUMBING I I SIGN <br />PROJECT ADDRESS <br />OWNER MAIL ADDRFSS CITY 7ir <br />Z-ky 7o7 p,194l.I& t✓ C f _ <br />TENANT MAILADDRESS CITY 711` <br />PHONE <br />PHONE <br />7-/3- 777-1 <br />ACga <br />MAIL <br />ONE <br />le,nh Lx/4 <br />M- ^bpo,fwgys <br />J¢ *le- <br />1803- <br />&NT]_/7UJ <br />Z�Z Y <br />GENERAL CON A TOR <br />MAIL ADDRESS <br />CITY <br />Zlr <br />PHONE <br />STATE LICFN"N-,z / 0 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATF LICENSE • <br />PLUMBING CON TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE IICENSEI <br />149Svu <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: GAS IIELECTRIC 11 _ <br />DESCRIBE WORK AND SQUARE FOPTAOE INVOLVED <br />d 9cc ,n a000 <br />CONTACT PERSON AND PHONE NO <br />I 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 WAC. <br />Kp � <br />PROPOSED USE OF BUIL(NNO <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />Lot BLOCK Or <br />-- <br />PARCEL TAK 10 NUMBER <br />CONSTRUCTION LOAN LENDER, ADDA.SS, TELEPHONE NUMRFn <br />. GHATURF. DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />_TYPE <br />A/C —AMNDLG UNITS —H.P. <br />' <br />BATHTUB <br />' <br />/ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />i <br />/ <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />I <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />i <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />' <br />OAS PIP114G <br />' <br />EXHAUSTFAN <br />I <br />� <br />I <br />I <br />' <br />I <br />' <br />SUB TOTAL S <br />' <br />SUB TOTAL S <br />' <br />PERMIT E <br />1 <br />PERMIT f <br />_ <br />TOTAL FEE $ <br />' <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAn SF TRACK <br />SIDE SETBACK <br />PLAN f.11ECKN <br />rir <br />RECEIPT NO <br />USE ZONE. <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I IYES rl NO <br />))EIGHT LIMITATION <br />NO OF DWELLING <br />SME OF BLD041 <br />)BATS <br />PLUMBING <br />RPCLTANCY W LK STINALS <br />nnam <br />OCCUPANT LOAD BASEMENT <br />MFC14AMCAL <br />nrFs n No <br />RRE ALARM REDO <br />REASON <br />ADOITIONAI. PLAN CHECK <br />OTHER <br />FInFSPnINKIERRFOD <br />RFASDN <br />STATE BIIIIDING SURCHARGE <br />TYPE OF CONST <br />PI ANS APPROVED DY <br />CITY OF EVERETT <br />PURnc WOnKS <br />— <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />