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APPLICATIO.. FOR CONSTRUCTIviN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 1,259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING pQ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: _ q65 eSt-�' & 3,C. <br />ARCHITECT OR DESIONER MAIL ADDRESS CITY Jn` PNONF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY Jm PHONE SIAIE LICENSE I <br />MECHANICAL CONTRACTOR MAIL ADDRESS City III, PHONE <br />CONTRACTOR MAIL ADDRESS <br />CONTRACT PRICE OF NyII <br />QSQUAREF <br />HEATING SYSTEM: RGAS Cl ELECTRIC El <br />DESCRIBE WORT( AND TAOL INVpLVlID <br />CONTACT PERSONAND 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 295.200 WAC. <br />I T onl� 10� <br />- <br />v OF 91ALOING <br />- L <br />LEGAL DESCRIPTION OF PROPERTY [SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />DATE <br />C3��D <br />CITY BUSINESS LICENSC NO <br />PLUMPING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C-NHNDLG UNITS <br />' <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />I <br />SHOWER <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />) <br />DISHWASHER <br />_ <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />; <br />SINK (SERVICE - BAR, ETC.) <br />GAS PIPING <br />I <br />' <br />EXHAUST FAN <br />I <br />I <br />SUB TOTAL f <br />; <br />SUB TOTAL f <br />' <br />PERMIT <br />PERMIT f <br />I <br />TOTAL FEE f <br />' <br />TOTAL FEE f <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PIANCIIFCXNIIMpFIT <br />FFt <br />RFCFIPT NO <br />USEIONE <br />LOT ARFA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />pLMDIND <br />I <br />❑YES ❑ ND <br />HEIGHT LIMITATION <br />NO Of DWELLING <br />S17E OF BLDO/TI <br />UNITS <br />1'LUMOINP, <br />, <br />OCCUPANCY <br />NO D SGKtl11 <br />OCCUPANT LOAD <br />BASEMENT <br />MR:IIANICAI <br />❑YFS ❑ NO <br />AIKKIMNAI I`I AN CHI CM <br />___ <br />i <br />I <br />FIRE SPRINKLER TIED <br />RF ASON <br />OTNIFR <br />' <br />I <br />FIRE ALARM REO'O <br />REASON <br />I <br />STATE RIIILDINO SHWHIARRE <br />TYPE Or CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PI ITT If. WORK' <br />- '- <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />