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APPLICATII.rd FOR CONSTRUCT iON PERMIT <br />CITY OF EVERETT • RDIVISION OL <br />3200 CEDAR STREET •EVERETT'ETT, , WA WA 98201 • 259-8810 <br />DEMOLITION I I COMBINATION I I BUILDING MECHANICAL I I PLUMBING I' SIGN <br />PROJECT ADDRESS <br />�+ R <br />MAIL ADDRESS <br />CITY <br />)II` <br />PII�y <br />I) A4 N l,�(ll TE <br />TENANT ^.0 <br />�1na Sam 5T <br />MMI ATIORFSS <br />5 = I <br />CITY <br />arT� �j9,aQ4i <br />lip <br />I�`t% <br />PIK)N <br />,, <br />ARCHITECT ORDESIGNFR <br />MAIL AODRESS <br />CITY <br />)IP <br />PHONE <br />-- <br />GENERAL CONTRACTOR <br />MAIL AOORSS <br />CITY <br />)IP <br />PIgNE <br />STATE IICENSFF <br />MECHANICAL CONTRACTOR <br />1 TRH I \ <br />MAIL AfNMFSS <br />PHONE <br />STATE LICENSE I <br />__.. _...-._.. .__.. ulY ZIP PHONE STATE I ICENSEI <br />CONj�ACT P ,E Of VYORR <br />l� <br />DF SC BE WORK ANO SOUARE FOOTMF 1 I7VED <br />_ <br />HEATING SYSTEM: XI GAS I I ELECTRIC I <br />CONTACT PERSON AND R ENO <br />EQ , y,n) �4 ��c <br />'IMTALL (nASFt)&t)pKF <br />j- <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 />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 C, 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 qCW AND 298.200 WAC. <br />X <br />PROPOSED USE OF BUILDING <br />LEGALWORK <br />lTEscmrnwaPROPERTV/slaWNeELowoaArucHTwDcorlEsl <br />LOT BLOCK OE <br />PARCEL TAx I o /HIRER <br />CONSTRUCTION LOAN 1 ENDER. ADLW ESS. TELEPHONE NIIMRER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />f TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—NHNDLG UNITS —H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />I <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />) <br />_ <br />DISHWASHER <br />' <br />VENTILATION FAN <br />I <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />I <br />URINAL <br />' <br />WOOD STOVE <br />I <br />DRINKING FOUNTAIN <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />BACKFLOW PREVENTERS <br />OAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />I <br />' <br />GAS PIPING <br />' <br />I <br />EXHAUSTFAN <br />_ <br />' <br />I <br />I <br />' <br />� <br />I <br />' <br />I <br />BUD TOTAL S <br />SUB TOTAL S <br />' <br />PERMIT S <br />1 <br />PERMIT $ <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SFTPACK <br />RFAR SETBACK <br />SIDE SETBACK <br />PLAN CIIFCK NU FP y <br />5-1 <br />FEE <br />RFCFIPT NO <br />USF ZONI <br />IOT ARFA <br />VACANT SITE <br />I YES ' 1 NO <br />FEES <br />VALUATION <br />FEE <br />PIIILMNG <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />SIZE OF SLOGR I <br />PLUMBING <br />OCCUPANCYIYI O STMISGROUP <br />OCCUPA'HLOAD <br />BASFMFNT <br />IYFS n NO <br />MECHANICAL <br />ADDITIONAI. PI At' CHICK <br />FIRE ALARM RFOD <br />REASON <br />OTHER <br />FIRE SPRINKIFRREOD <br />AE ASM <br />STATE BUILpIN0511RC,W\IKRE <br />TYPE OFC-ONST <br />PIANSAPPROVTDBY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />Pion IT..W(MK5 <br />4L7�4 <br />TOTAL <br />I <br />