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APPLICATIIoN FOR CC�NSTRUCI"r''ON PERMIT <br />i fhe Evergreen <br />` CITYOF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COM9INATION ❑ BUILDING f�MECHANICAL <br />� � <br />❑ PLUMBING <br />everett � <br />� <br />� <br />❑ SIGN <br />GENEflALCONTflACTOfl NAILAODHESS CITV 21P PHONE LICENSE� <br />.���ueu�rerinutwerma i uan.GnrwF55 . CITY ZIP PHONE LICENSE/ � <br />CONTflACTOq <br />, cm <br />J/� <br />� J' <br />PHONE <br />ULENSE � <br />❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION � WOO�STOVEIFRPL INSERI' ❑ BUILDING RELOCATION � <br />TENANTIMPflOVEMENTOPINTENIONREMOOELONLV I COYTACTPER.ONANOPHONENO. �� <br />�iwrnecr ooicc na wno¢e . <br />LOT 9lOCK OF <br />,PR0.IEGTADORE55 <br />� lp50-3 - �UveG i2�e.e.iievfJ-+ <br />�L <br />OR ITEM <br />LAVATORY (WASH B <br />SHOWER <br />KITCHEN SINK 8 DI: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />BACKFLOW PREVENTERS <br />ROOF DRAI�S—RAINLEADERS <br />FH�NTSETBACK <br />USEZONE <br />ttPEOFCONST.ALLGWMIE <br />SIZE OF B�D�. <br />OCCUPANCYLOAD <br />flEA50N FOfl SPRINKLEflS <br />POUf1COPIES� <br />I HEREOY GEHIIFY It1AI I FIAVt titAV ArvU L•AAMIrvtV InIJ , <br />APPLICATION AND KNOW THE SAME TO BE TRUE At:D CORRECT. ALL � <br />PROVISIONS OF LAWS AND 05DINANCES GOVERNIN(i THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WH�HER SPECIFIED HEflE�N OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TQ GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PflOVISIONS OF ANY � <br />OTHEfl SPATE OR LOCAL LAW REGULATIIJG CONSTRUCTION OR THE , <br />PFflFORA1AIJCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br />OWNER OF TIiIS PROPERTY TO PEflFORM THE IVORK FOR WHICH � <br />APPLICATION IS MADE AND I COMPLY WI711 THE STATE <br />CONTRACTORS LAW 1B.27 RCW AND 296.200 Nl.4C. <br />SIGNATUREOFCONTRACTOflOFAUTH0fl12F�AG2.�T �ATE <br />x .� �-� �%l _ � /, <br />p�� <br />Ji APPL ANTSGITY <br />! <br />SUB TOTAL $ i <br />PERMIT $ � <br />TOTALFEE $ ' <br />REARSETBACK SIOESETBACK <br />tOTAREA �ACAHTSITE <br />❑ YES ❑ NO <br />NO. <br />rtt <br />A/C—A/HNDLG UNITS—H.P <br />FORCED AIR SYSTEMS-8 <br />UNiTHEA'iERS—B.T.U. M <br />CI.OI�HER �RYERS <br />VENTILATION FAN '�— <br />RAIdGEH00D �/i C�. <br />WATER HEATER <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PIAN LHECH NulADER <br />euaewc <br />TYPEOfCONSi.ACiOAL �P�' Ao.aoxtwHouxns <br />GflWP pLUM81NG <br />NOAF STofilES BnSEUEN7 MECHANICAL <br />n ves ❑ No <br />FIflESPRNRLEPSREO'D HEIGNTIIMITATION OTHER <br />] YES ❑ NO STATE BUILDIIJG SUF7CHARGE <br />APPLICATION ACC. UV PlANS A?PROVED BV <br />�� <br />l�nJurY / /��� V-.�(' %i�� :rv <br />STAT=ENERGYSURCHARGE <br />CITY OF EVEREIT PUBLIC WOFiHS <br />LOCAL SALES <br />TAX COOE IS 31U5 TOTAL <br />��3 (j' S� � " 2 3 ��'� <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />FEE flEGEIPTNO. <br />FEE <br />