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APPLICAThA4 FOR CONSTRUC•I, mON PERMIT <br />Cl I Y OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET •EVERETT, WA 98201 •259-8810 <br />11 DEMOLITION <br />I I COMBINATION <br />I I BUILDING <br />I I MECHANICAL I <br />PLUMBING <br />I I SIGN <br />PROJECT ADDRESS <br />2L <br />A-0-) <br />/ L' <br />a <br />c L <br />IJ C� <br />JWNE <br />�v-•r_ <br />MML ADDness <br />CITY <br />o f-4 <br />P1• <br />ZR' <br />51-- !7z <br />PHONE <br />: .3/S- <br />TENANT <br />MAILADORESS <br />CITY <br />21P <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADORE SS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE II <br />-r-J_ . I e- c A <br />cc . )1% <br />CONTRACT FRICE OF WORK <br />`;;1 6 0 <br />HEATING SYSTEM: I I GAS ELECTRIC fl <br />DESCRIBE 77ANDSWARE 00740E INVOLVED <br />CONTACT PERSON AND PHONE. NO <br />1 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 THIP TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A III 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 10 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR TORS RCW AND 298.20n WACyF., <br />X //_ • —�-/ <br />PROPOSED USE OF BUILDING <br />LEGALDESCRIPTIONOF PROPERTY (SHOWN BELOW ORARACH TWO COPIES) <br />LOT BLOCK of <br />o D - d o — o u L / <br />PARCEL iAK ID. NUMBER <br />CONSTRUCRON LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATI DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MEChANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —AAiNDLG UNITS —H.P. <br />�— <br />BATHTUB <br />' <br />FORCED AIR SYSTES—B.T.U. M E.A. <br />`_ <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEN. ERS—B.T.U. M <br />' <br />KITCHEN SINK d DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />1 <br />VENTILATION FAN <br />I <br />LAUNDRY TRAY <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />I <br />URINAL <br />I 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 />I <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />) <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />I <br />' <br />GAS PIPING <br />' <br />1 <br />EXHAUSTFAN <br />I <br />I <br />— _ <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />' <br />PERMIT <br />S <br />I <br />PERMIT $ <br />TOTALFEE <br />$ <br />' <br />TOTALFEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CIIEC NUMBER <br />FFE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />GUILIANO <br />nYES n NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDORI <br />UNITS <br />PLUMBING <br />OCCUPANCY NO Or SIC FiFS <br />OR OUP <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />IlYF.S n NO <br />ADDITIONAL PLAN CHECK <br />FIREALARMAEO'D <br />REASON <br />OTHER <br />FIRE SPRINKLER AEG <br />REASON <br />I <br />STATE BUILDING SURCHARGE <br />' <br />TYPE OF CONST <br />PLANS APPROVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />) <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />