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�i <br />, <br />APPLICATIt��I FOR CONSTRUCT��ON PERMIT <br />, <br />� fhe Evergreen <br />i CITYOF <br />everett <br />BUILDING DEPAHTMENT <br />259-8810 TO BE GUMPLETED IN INK—PLEASE FRINT <br />O DEMOLITION I.1 COMBINATION I I BUILDING 'KI MECHANICAL I J PLUMBING <br />/OW1NER � MAILADqDRESS Cl/TV 21P PIIONE <br />i llic�/lf/"��-��rC� �JLl^✓ 73'� GC� LcY/s�C�✓j �%����u� %7y-�%/�1J <br />TENAC�N� / MRILAOORESS CITY / ZIPp PHONE <br />�Xsln�OA Cd�/4'�5 �ZD S�ao� �`✓hl'!� �i?c!� �(,�uy , Sia/� �F'. /�j�jlc�� <br />�� <br />MAI� AODRE55 <br />everett <br />� <br />❑ SIGN <br />/ xi ^ i resnr <br />O�E ALCONTflACTOH MAILAD�RESS CITV ZIP PHONE IICEN5E1 <br />( Rix'l/�`iv<%-«�.�ry C�Pf�-siyzo7 <br />MECHA ICRLCONiRAC'OR MRILAODflE55 CITY ZIP PHONE LICENSEN <br />PLUMBINOCONTRACTOR MAILA�DRESS CITV ZIP PIIONE UCENSE� <br />�NEW U ADDITION 1 I ALTERATION I. I REPAIR 1 I DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />NEMENT Ofl INTEflIOR REMOOEL ONLV <br />CEOFWOflN: �IO` <br />iK ANO SOUARE FOOTAGE INVOLVED <br />/i <br />'C/N '}�C+�7 !�fl9t <br />= OF BUILOING <br />F re f-� J 5( �3 <br />LEOAL DE�CRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT 6� � BLOCK OF l'e"L!! LtfY C <br />PqRO�JECTAOOPESS <br />G!J >iDd� �✓�PI'C!( �I��CG6 <br />PLUMBINQ <br />NO. 1 YPE OF FIXTURE OR <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHVUASHER <br />LAUNDRYTRAY <br />BACKFLOW PREVENTERS <br />ROOF DFiAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FFONTSETBACK <br />USE ZONE <br />1YPE OF LONSf. AIIOWAtlLE <br />SIZE OF 6lDG. <br />OCCUPANCVLOAD <br />REASGN FOR SPPINNLERS <br />REARSETOACK <br />LOTAREA <br />IYPE OF COHST. AC7UAL <br />NO. OF STOAIES <br />FIPE SPRNNLE(iS REO'D <br />l I YES f I NO <br />APPLICATIONACC.BY I PLANSAPPROVEDBV <br />� <br />FEE <br />cIOE SETBACK <br />VACANT SITE <br />I I YES I�1 NO <br />PEFSON ANU PHONE NO. <br />nr�. �.1%ii/. <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORIT'+ TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEP 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 FOfl WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUfiEOFCONiflACTORORqUTHORIZEDAGENT �ATE <br />X � � ��/ <br />' 7 /.i ,(,C/ ' <br />l.L <br />APPIIG S I YBUSINE9 LICENSENQ' NUBUSINESSNAME <br />AIC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />PLAN CHECH NUMUEfi <br />Bli:IDING <br />occuosxc xaao-x[wxauxns - <br />Gfl�P F! UM811IG <br />BASEMEN7 MECHANICAL <br />I�. I YES I I NO <br />HEIGHTLIMITATION CTHER <br />SiATE BUIL�ING SURCHARGE <br />STATEENERGYSURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SA.LES <br />7AX CODE�S 3105 TOTAL <br />SUB'fOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE RECEIPTNO. <br />■� <br />�� <br />N <br />H <br />� <br />