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APPLICATIOW FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I I UrMUL111UN I ! COMBINATION BUILDING MECHANICAL ' PLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />z� � rvErMa1�E ic- <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />(�l IV( 0- <br />TENANT MAIL AD/DRREESSS/ CIITTjY ZIP PHONE <br />I�yw Wid <br />ARCHITECT OR DESIGNER MAIL ADDRESS 1 DITY ZIP PHONE <br />t;L:rvLHaLc v1RnC10R '1 <br />M ILADORESS CITY <br />ZIP <br />PNO <br />SUt[IICENSF.� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONIRACTOR <br />7411.ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE• <br />CONTRACT PRICE OF WORK <br />c) 3Y <br />HEATING SYPTEM: I I GAS ' ' ELECTRIC f� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />-�-�s <br />CONTACT W RS N 1N0 PHONE NO <br />%� Ztfl- PP 10 <br />WAU atw, ZQ - Polk <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 />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 AU i HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT V TO CW AN 296.200 WAC, <br />X � O <br />T <br />Pr1DPoseD usE of BUBOINc <br />LEGALDESCRIPTION OF PROPERTY (SHOWN BELOWORATUCH TWOCOPIES) <br />LOT BLOCK OF <br />PARCEL TAY I.D. NUMBER <br />CONSTRUCTION I CAN LENDER. ADDRESS. TELEPHONE NUMBER <br />BIG1 I DATE <br />CITY BUSINESS I ICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C—AMNDLG UNITS — H.P. <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />_ <br />SUB TOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMB <br />/)( c <br />FEP <br />RECEIPT NO <br />USE ZONE <br />107 AREA <br />VACANT SITE <br />AYES I I NO <br />FEE <br />VALUATION <br />FEE <br />BUILDING <br />?p <br />�— <br />I <br />"EIGHT LIMITATION <br />NO OF DWELLING <br />UNITS <br />lD(i/T.I <br />SIZE OF 'LIT. <br />D SO <br />PLUMBING <br />OCCUPANCY <br />GB 11P <br />- <br />NO LN STORES <br />�, / <br />N41 <br />OCCUPANT LOAD <br />. I <br />/ `� 7 <br />BASE NT <br />FIVES FINE) <br />MECHANICAL <br />-�- <br />I <br />r <br />ADDITIONAL PLAN CHECK <br />FIREAURM REDD <br />E S <br />REASON - <br />bone ogo <br />OILIER <br />; <br />FIBF. SPRINKI ER RED D <br />YrS <br />REASON 0110,r <br />(ID DCf T <br />1 <br />STATE BUILDING SURCHARGE <br />ruBnc wones <br />_ <br />TYRE OF C,ONS1 <br />PLANSOVED BV <br />i <br />DATE I-2Q-SJ <br />_ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />n <br />; 7 A <br />1 <br />