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AFFLIUATION FOR CONSTRUCTF-1N <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-88'0 <br />DEMOLITION f7 COMBINATION ❑ BUILDING ❑ MECHANICAL <br />PROJECT ADDRESS:_- __ o / r7z�d <br />sr, 154 " _ J/ z c%I .1. r <br />PERMIT <br />�* <br />❑ PLUMBING ❑ SIGN <br />O <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITFCT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GFNERALCONTTMCTOR <br />LIAIL ADDRESS <br />CITY <br />ZIP <br />PILONE STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PILONF STATE LICENSE <br />PLUMBING COiTBACI <br />MMl AODRE <br />CITY <br />ZIP <br />SON .Z STATE LICENSE I <br />EIri4A� <br />FCNTRACT PRICE OF WORK <br />j ! Y G ( <br />— <br />SYSTEM: & GAS ❑ ELECTRIC ❑ <br />DESCRIBE K AND SOl1ARE FOOTAGE INVOLVED <br />JHEATING <br />CT PERSON ANE, PHONE —No <br />EREBY 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 Or 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 AUTHOHIZED BY THE <br />OWNER OF TH;S 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 />X <br />SIGNATURE DAT -- <br />PROPOSFO1 SE OF BUILDW <br />LEGAL DESCRIPTION or PRorEnTr lsNlovm eElGw OR ATTACH Two corlEsl <br />LOT BLOCK of <br />PAROFL TAX 10. NUMBER <br />CONSTRUC TION I CAN LENDER, ADDRESS. TELEPHONE NUMBER <br />CITY BD$IN SS I ICE VSE NO <br />PLUMBING <br />WECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />1 TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—AMNDLG UNITS <br />I <br />BATHTUB <br />—BASIN) <br />' <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH <br />I <br />HEAT PUMP <br />, <br />SHOWER <br />' <br />UNIT HEATERS <br />I <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <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 />I <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />FLOOII DRAIN <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />GAS PIPING <br />' <br />, <br />SWK(SERVICE —BAR, ETD.) <br />I <br />' <br />EXHAUSTFAN <br />I <br />I <br />, <br />I <br />I <br />, <br />I <br />_ <br />' <br />I <br />_ <br />SUBTOTAL S <br />SUBTOTAL S <br />' <br />_ PERMIT $ <br />I <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <br />- ?� <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SFTBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RFCFIPT NO <br />IISE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF BLDGR I <br />PLUMBING <br />JCCUPANCT <br />UROOP <br />Iq (K STOUFS <br />OCCUPANT LOAD <br />BASEMENT <br />OYES Cl NO <br />MFf,IRANICAI <br />ADDITIONAL Pt AN CHECK <br />— ---- <br />FIRESPRINKLERREO'D <br />REASON <br />OTHER <br />FIRE ALARM REO'D <br />RF ASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PLANSAPPPOVED BY <br />CITY OFEVERETT <br />LOCAL SALESALFS <br />DATE TAX CODE IS 3105 <br />ruenOwORKT; <br />TOTAL — <br />---- <br />