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APPLICATIGA FOR CONSTRUCT, JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: I)' E/(p IV&2Y1 S7 SE <br />Al �L cn s q) Ln 93� 37 5 F &'Zlr'nE77 c7 rZo <br />owNEa MAN AFAAEe S .3/17- / �J/ _ <br />TIP <br />ARCHITECT ON DESIGNER MAI ADDRESS CITY <br />)'r PIgNE <br />GENEIIAL CONtPACTOR MAIL ADOOESS CITY <br />ZIP PHONE SIAIE LICENSE <br />DESCRIBE MORN AND SOIARE FOOTAGE INVOVED <br />K / <br />CL /I 4I21 O n f -�) irk <br />L <br />PROPOSE USE tK BUILDIIq <br />IEGAI DESCRIPTION OF !'1101'e: 11 ISIgWN BELOW GR ATTACH iVp CONESI <br />LOT BLOCK <br />or <br />PARCEL TAXI NUMBER <br />CONSTRUCTION 1OAN LEN ADMADDRESS. TEL"NONE NUMBER <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC n <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT 1 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 16 27 RCW AND 296.2DO WAC. <br />SKiNATunE DAZE <br />CITY RUSINE SS LICENSE <br />N-0 1 TYPE OF FIXTURE OR ITEM <br />FEE NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />FEE <br />BATHTUB <br />' A/C—A/HNOLG UNITS <br />—�— <br />_ LAVATORY (WASH BASIN) <br />' FORCED AIR SYSTEMS <br />, <br />SHOWER <br />, HEAT PUMP <br />' UNIT HEATERS <br />i-- <br />' <br />KITCHEN SINK A DISP <br />DISHWASHER <br />� CLOTHES DRYERS <br />I <br />LAUNDRY TRAY <br />RANGE HOOD <br />, -- <br />' <br />CLOTHES WASHER <br />WATER HEATER <br />, <br />URINAL <br />, WOODSTOVE <br />' <br />' METAL FIREPLACE (WOOD BURNING) <br />, <br />DRINKING FOUNTAIN <br />; <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />, GAS FIREPLACE <br />' <br />GAS RANGE.) <br />, <br />SINK (SERVICE — pqq, ETC <br />' GAS PIPING 'r I. <br />' EXHAUSTFAN <br />' <br />, <br />, <br />, <br />, <br />SUB TOTAL f <br />' SUB TOTAL f <br />' <br />PERMIT f <br />, PERMIT f <br />, <br />TOTAL FEE f <br />TOTAL FFF t I, <br />FOR OFFICE USE ONLY: <br />l RONTSFTBACK <br />REAR SFTRACK <br />SIDE SETBACK <br />PIAN, IIECk NLIMLIFIT <br />FEE RFremT No <br />// � <br />J/I // <br />USE ZONE <br />IOT AREA <br />VACANT SITE�ES <br />VALUATION FEE <br />DYES ❑ NO <br />a NIrn Ns <br />, <br />IIEIOIIi [IMITATION NO O DWELLING SIZE W BIDnRi <br />UNITS <br />PlII4111N0 <br />i <br />OCCUPANCY ND OFSIMES <br />OCCUPANT LOAD <br />BASEMENT <br />I <br />MFCIIANICAI <br />❑YES ❑NO <br />FIRE SPRINKLER REO.O <br />RF ASON <br />-- <br />ADDIIMNAI fN AN CIIl CN <br />I <br />oD En <br />-- <br />I <br />1 <br />FIRE HARM REO'D RF ASON <br />SUIT nu town SIIACHAPGE <br />TYPE ar.ONsr <br />PUNS APPIIOVEn BY <br />CITY OF EVERETT <br />rum IC WONKR <br />r <br />LOCAL SALES <br />TOTAL <br />i <br />DATE TAX CODE IS 3105 <br />_1 <br />