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�t�1� <br />��x <br />�H[HA <br />H�� <br />tC f] <br />H �1 <br />�N� <br />V] H <br />Hx <br />Ci1 O <br />H C7 <br />OH <br />H�g <br />�1]Y (] <br />�H� <br />z <br />Hy <br />gy <br />� <br />i-i C❑ �n <br />C+7 <br />� y� <br />H O CA <br />-� � <br />APPLICATION FOR CONS'► RUCTION PERMIT <br />Ihe Evergmon <br />CITY OF <br />everett <br />BL'ILDING DEPARTMENT <br />259-6810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I: i DEMOLITION ❑ COMBINATION I 1 BUILDING I7 MECHANICAL 17 PLUMBING <br />everett <br />� <br />❑ SIGM <br />�aao ilo�,s�o.,, �exar ��os� �7/3) -,�GG-�6�/� <br />ARCHITECTOPDESIGNER MAILADORE55 CIlY ZIP PHONE <br />MECNANICAL <br />CITY ZIP <br />CIIY 21P <br />, �.." _ _.n.� <br />PHONE IICEN5E1 <br />PIIONE LICENSE I <br />/�� i�.�. . ... <br />❑ NEW ❑ ADDITION ❑ ALTERATION C I REPAIR I.1 DEMOLITION I I WOODSTOVFJFRPL INSERT LI BUILDING RELOCAiION <br />TENAHT IMPROVEMENTOP INTERIOR REMOOEL ONIY CONTRCi PERSON AND PH011E NO. <br />f.ONTNAGT opICE OF WOPN: <br />LOT OLOLN <br />PPQIECT ADOlifiSS <br />s <br />Yflq�i�ill�l <br />iz.z•» <br />FfiONi SETBACN <br />USE20NE <br />IYPEOf CON57 AIIOWRBLE <br />SIZE OF BLDO. <br />OCGUPANCYIOAD <br />RE450N FOf15PRiNNLERS <br />APPLICRTIpJACC.BY <br />OF <br />� <br />u <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMI�ED THIS <br />APPLICATION ANC KNOW THE SAME TO BE TRUE PND CORFEGT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE Gr <br />WORK WILL BE COMPIETED WITH N:HETHER SPECIFIED �IEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME f0 GIVE <br />AUTHORITY i0 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PE(iFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI7ED BY THE <br />OWNEF OF THIS PROPERT� TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATUf1EOFCONIMCTOROH�UI110NZEDRGENT D�TE <br />_)`AIG�Fi i�/ii/l� � <br />AP tSCIiY0U51NE5SlIGE N ��I 'USINESSN�ME <br />MECHANICAL <br />NO. TYPEOFEOUIPMENT FEE <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIFi SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />—� <br />CLOTHES DRYERS � <br />VENTILATICN FAN i <br />RANGEHOOD —� <br />/ WATER HcATER Li� J7O <br />HEAT <br />Iy:1J <br />SUBTOTAL $ ;OU SUBTOTAL <br />PERMIT $ PERMIT <br />TOTALFEE $ ' QD TOTALFEE <br />REAR SEID�CN SIOE SEIDALN PLAN GHECK NUMOER FEE <br />�otanea VACANTSIIE FEES VALUATIO� <br />❑ YES fl NO <br />- _ BWl01NG . <br />IYPEOfGONSi.AC1UAL �urnucv rmaw.nuxcuxns <br />cnav pLUM91NG <br />1lO.OFSTORIES 0/.SEMENT MECHANICAL <br />❑ YES 1 I NO <br />FlRESPRNNLERSf1E00 IIEIGIIiLIIAItN10N OTHEB <br />U YES ❑ NO STATE BUILOING SUflCHAF�E <br />STATE ENERGY SURCHAfiGE <br />PUNSAPPpOVE00Y CITY OF EVERETT PUBLIC WOfINS <br />LOCAL SALES <br />TAX COOE IS 3105 rora� <br />