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Crl b7 � <br />��x <br />>H� <br />4x9 <br />y5H <br />K �i <br />H� <br />0 �i� <br />'i1 H 'il <br />y H <br />H <br />x <br />�HC <br />ON <br />��g <br />Siv �'] <br />H �. <br />H <br />�H� <br />gy <br />� <br />�d5� <br />L'Jr�y <br />HOy <br />�r ,� <br />APPLIC,ATION FOR CONSgRUCYION PERMIT <br />ihe Evergiean <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION [J BUILDING fIMECHANICAL 17PLUMBING <br />owrven rnf anooness p � (�� cirv nr ..��or�e <br />��T- /�'CJn �(?�iYlL7RJ.LfC �o�do i%i�r�on, 1�exdl 77oS7 i7�3 -,�GG <br />N4Ni MRILpDDf1ESS ✓ CITY ZIP PNONE <br />AliL111TECTOf10E51GNEN MNLAOORE55 CrtY 2iP PHONE <br />GENERALLONtP�CiOf1 MNLAOOflE55 CItY ZIP PMONE UCENSE� <br />MRILAOORE55 <br />uni� <br />rirone <br />ueense+ <br />e�erett <br />� <br />❑ SIGN <br />clnsSOFwon� - �-. .-. _.• - V. � - �, <br />L_I NEW f_7 AD�ITION ❑ ALTERATION I.I REPAIR I I DEMOLITION I I WOODSTOVE/FPFLINSERT IJ BUILDINGRELOCATION ' <br />TENANT IMPPOVEMENt OR INTEFIOR REMOf1EL ONLV CONTAU PFRSON �ND PHONE NO. � <br />CONTRACT PRICE OF WORK: ' <br />DESCRIBE WOPK ANO SOUARE FOOTFGE INVO�VED . <br />IEG�L <br />�o* <br />PR0.IEGT AOOPE55 <br />BLOCK OF <br />FouA coriesi <br />� <br />I HEFiEBY CERTIFY THPT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AKD CORRECL ALL , <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF '� <br />WORfC WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br />NOL THE GRANTINC. OF A PERMIT DOES NOT PRESUME TO GIVE �� <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY I <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE . <br />PERFORMANC� OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE '��� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNAIUf1EOfCONTRAC10110R�UtNORREDFGEYT DRTE � <br />///f � <br />PlIG�tN /i/�/�/ _ �//rii�iL'"//!il/� <br />BP iSCItY0U5W[SSIICEpY,�N�S.�51NE55NAlAE I <br />!/ I <br />NO. TYPE OF FI%TURE OR �TEM FEE N0. TYPE OF EOUIPMENT FEE 'i <br />WATER CLOSET (TOILET) /� � f.}� NCrA/HNDLCa UNITS—H.P. �I <br />� BATHTUB �S i(70 FORCED AIR SYSTEMS—B.T.U. M E.A. ! �, <br />3 LAVATORY (WASH BASIN) /l,S� DU UNIT HEATERS—B.T.U. M ; <br />SHnwca --� � f.1/1THFS OfiVERS � I <br />KITCHEN SINK 8 <br />DISFiWASHER <br />LAUNDRYTRAY <br />I LLN3y[�L"l•]:Id4�11��9 <br />FRONfSETOPGK <br />USE ZONE <br />IYPE Of CON57. PLIOWABIE <br />51ZE Oi OL�. <br />OLGUPANCYLOAO <br />f1E�50N F085PPINRLEflS <br />�PPLIC�TIOY RCC. B'/ <br />I:Tdd[e1� <br />PERMIT $ <br />TOTALFEE $ � ;Q <br />REMSETBrCK SIOESEIOACK PL�NGPECKHUMOER <br />LOtARE� V�CANTSITE FEES <br />❑ YES I.1 NO pUILDING . <br />tYPEOFCOHSi.ACiUAt acurextv uo ornxfluxauxns <br />cnwr <br />PLUMBING <br />NOAFSTONES OnSEMENi MECHANICAL <br />1.] YES LI NO <br />FIIIESPfiNKLERSREO'D HEIGHTLIMITAiION OTHER <br />❑ YES ❑ NO STAiE BUILDING SURCHppGE <br />STATEENERGVSURCHARGE <br />PLFNS�PPROVEOOV CITYOFEVERETT rueucwo�Ks <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />8 <br />PERMIT 5 <br />TOTALFEE $ <br />FEE f1ELEiPTNO. <br />7 <br />