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[+f �a � <br />O 7J x <br />>Hf~i� <br />4� <br />K n <br />H R1 <br />�H� <br />VJ H <br />l-I � � <br />Hl7 <br />OH <br />H�g <br />S]Y �] <br />t"y� <br />[�i� y <br />g H <br />n d5 � <br />L'I <br />�H� <br />HO�n <br />m <br />�.. ... <br />APPLICATION FOR CONSTRUGTION PERMIT <br />�he Evergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />f7 DEMOLITION fl COMBINATION I I BUILDING I l MECHANICAL I-1 PLUMBING <br />everett <br />� �i <br />❑ SIGN I <br />pyn��q I�A/AR�OORE55 CIIV 21P PHOIIE '�. <br />2t r�i___, �,_i7� Ly'D/7 Qe�e���+mr�—(!� �Jdv f%yrl�o.� ,_l�exdf J70S7 i7/ 3� -� GG -��/v <br />N�NT MRILF�DRE55 V ��TY ZIP PHONE �� <br />ARCNITECTORUESIGNER MAILR�ORESS QTY ZIP PHONE ' <br />MAI� RDURESS <br />MECIUNICAL <br />1:11Y L�Y <br />CIiY 21P <br />CITV 2�P <br />PnVne ub[Rae� <br />PIIONE UGENSEI <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR [ 1 DEMOLITION f I WOODSTOVE/FRPL INSERT ❑ BWLDING RELOCATION <br />iENANT IMPflOVEMENT OR INiEfiIOR REMOOCL ONLY CONtAGT PEPSON �ND PIIONE N0. <br />CONiPRCi PPICE OF WORK: <br />oF5Ci1�BE WOBK ANO SOUME FOOT�GE INVOLVED <br />PROPOSED USE OF OI/ILDIHG <br />�n'�c <br />LEG�L 0�SCRIPTION OP PRUPERTY �SNOWN OELOL <br />LpT BLOCK _ OF <br />aooaess <br />R1G1/@Ccl <br />FPONiSEtp�CN <br />USE ZONE <br />trre ov coNsr. nuowaoiE <br />SIZE OF OLDG. <br />OCLUP�NCYLOAO <br />REPSON FOR SPRINHLERS <br />pPPLICR110N 4CC. DY <br />G7:1 <br />[3 <br />roua cories� <br />r'� <br />I HEFiEBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Op <br />NOT. THE GRANTING O� A PERMIT DOES iJOT P�cSUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER 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 FOR WHICH <br />APPLICATION IS MADE AND I COMPLY W�TH TFIE STATE <br />CONTRACTORS LAW 1827 RCW �ND 296200 WAC. <br />SIGNATUf1EOFCONiRACtOROf14UiHOflIZEDGGENT 04LE <br />X <br />AP TSGITYBUSINESSLICE N .A USINESSNRME <br />MECHANICAL <br />JO. TYPE OF EDUIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P, i <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M i <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 <br />REApSET��CK SIOESETBAGK PLANCHECKNUAI9ER I <br />J <br />LOTAOU VALANTSIIE FEES <br />IJ YES I I NO OUiLDING <br />iYPE OfCONSCpCtOPL Ottu�u+tr no d Uw[�uxcunns <br />��aP PLUMBING <br />NO.OFSTONES DASEMENT A7ECHANICAL <br />❑ YES LI NO <br />FIRESPRNKLERSFi00 NEIGHTLiMITAiION �7HER <br />❑ YES ❑ NO STFTE BUILUING SUI;^NA(i.^-_ <br />STFTEENERGVSURCHARGE <br />PlANS�PPROVEOBY CITY OF EVERETT PUBLIC WORH$ <br />LOCALSALES <br />TAX COOEIS 3105 I TOTAL <br />TOTAL FEE $ � <br />FEE RECEIPiNO. <br />VALUATION FEE <br />T <br />i—_ <br />ScoS ',� <br />�Gl� '�— <br />OV <br />