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APPLICATIn FOR CONSTRUCYI 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: <br />V93Y4 { (afat,4 n, <br />TENANT <br />Z58 - <br />ARONIrECT IA DEwNER MAIL ADDIIEss cRY nP E PNUNF c2wF1<A1 G 1 e <br />�ctif►+s�f Ga►��,f 7;oN l-7is to'lu R Bit �--Lc-yTr J;�?yt 33L-2t14 091 3 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE IICENSEA <br />MECHANICAL CONTRACTOR MAA ADDRESS CITY ZIP PHONE STATE LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DE4DME' •( SOl1ARE FOOTAGE INVOLVED <br />R 1�+ <br />coMucr PERSON NOD _ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROVISIONS <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 1 COMPLY WITH THE STATE <br />CONTRAC A 8.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE of BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT Bloat a <br />PARCEL TAX 1.0. NUMBER <br />CONSTRUCTION LOIN! LENDER. ADDRESS. TELEPHONE NUMBER <br />SKSNAT ` I 66-7GATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <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 />' <br />A/C —AMNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />) <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />) <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />' <br />� <br />I <br />I <br />' <br />T—' <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT $ <br />I <br />PERMIT S <br />TOTAL FEE f <br />' <br />TOTAL FEE $ <br />FERN OFFICE USE ONLV- <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CIIECK NUMBER <br />FEF I <br />RE.'EIPT NO <br />USEZONE <br />IOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/� <br />ZO i <br />DYES ❑NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGITI <br />UNITS <br />1 <br />PLUMBING <br />OCCUPANCY <br />NO D SIORFS <br />OCCUPANTLOAO <br />BASE T <br />MECHANICAL <br />GROUP <br />_ <br />_ <br />❑YES ❑ ND <br />ADWTIONAL PLAN CH(.CK <br />i <br />�— <br />FIRE SPRINKLER REO'D <br />REASON <br />GTITER <br />FIRE ALARM REO'0 <br />RF AS <br />STALE BUILDING SIIRCNADGE <br />TrPE OF roNSTG/ <br />LA <br />PNS APPROVED BY <br />CITY OF EVERETT <br />PURI Ic WORKS <br />f'� <br />' �M <br />LOCAL SALES <br />�— <br />TOTAL <br />��C� <br />'% Lj/1 <br />TAX CODE IS 7105 <br />DATE <br />